Can Testosterone Replacement Therapy Harm Your Heart?

When men begin to experience signs and symptoms of low testosterone, such as loss of libido, waning muscle strength, encroaching abdominal fat, tiredness, brain fog, and erectile dysfunction, some seek out testosterone replacement therapy (TRT). After all, all those internet, television, and radio ads can’t be wrong, right? Got low T? Replacement therapy can solve your problems and make you feel like a man again.

Although TRT may seem like a great way to boost your T levels, there are some things you should know about testosterone therapy and the heart.

Use of testosterone replacement therapy

Given the high interest among aging men to take testosterone therapy, understanding the risk is important and should be discussed thoroughly between doctors and their patients. In fact, while reported rates of low testosterone among men have been static, prescriptions for TRT have climbed over the past two decades.

This rise in TRT reflects how the hormone is being increasingly prescribed and used for indications outside of the FDA approved reasons. According to the FDA, those reasons are as follows: “Testosterone is FDA-approved as replacement therapy only for men who have low testosterone levels due to disorders of the testicles, pituitary gland, or brain that cause a condition called hypogonadism. Examples of these disorders include failure of the testicles to produce testosterone because of genetic problems, or damage from chemotherapy or infection.”

Testosterone therapy and the heart

According to the findings of a new study from researchers at McGill University in Montreal, men who took testosterone therapy were at an increased risk of mini strokes (TIAs), stroke, or cardiac arrest during the first two years of taking the therapy. Data from about 15,400 British men aged 45 and older who had age-related low testosterone levels were evaluated for the study.

When compared with men who did not take testosterone replacement therapy, those who did had a 21 percent higher risk of cardiovascular events, including stroke, mini-stroke, or heart attack. This increased risk declined after two years of the hormone therapy.

One of the study’s authors, Dr. Christel Renoux, of the departments of epidemiology, biostatistics, and occupational health and the department of neurology and neurosurgery at McGill, explained that the evidence on long-term clinical benefits of using testosterone therapy in healthy men who have “modestly declining levels” of the hormone is limited. “We strongly recommend that clinicians proceed with caution when considering prescribing [testosterone therapy].”

Not all studies say TRT carries a cardiovascular risk. Some research suggests its use is associated with a lower risk of death from any cause, although past evaluations have noted an increased risk.

Between January 1, 1999 and December 31, 2010, for example, more than 44,300 men with androgen deficiency (serum testosterone less than 300 ng/dL) were evaluated. Of these, 8,808 (19.8%) had ever taken TRT and 35,527 (80.2%) had not. At a mean follow-up of 3.4 years, the risk of cardiovascular events was lower in the men who took TRT than those who did not. 

More recently, in a May 2019 article appearing in Nature Reviews Cardiology, the authors noted that the true impact of testosterone replacement therapy on cardiovascular health remains uncertain.

In fact, the experts made the following observations:

  • Some retrospective studies have shown a greater risk of cardiovascular events in men who are taking TRT, and the risk rises early after treatment begins
  • Meta-analyses of randomized, controlled trials have demonstrated conflicting findings, and this is likely due to various causes, including studies that have been too short to adequately evaluate cardiovascular events
  • The first trial (TRAVERSE) that is considered to be properly powered to evaluate cardiovascular findings among men using testosterone replacement therapy was initiated in 2018, and it will be approximately 10 years before the results become available

Until medical professionals have more information about testosterone and the impact on the heart, the authors recommend that physicians make their decisions about prescribing testosterone therapy on a case-by-case basis, especially in light of any personal or family history of cardiovascular problems. Doctors also should thoroughly discuss the risks and benefits of TRT with their patients.

Look for an alternative? Click here to read about how to find natural and effective testosterone supplements.

References

Cheetham TC et al. Association of testosterone replacement with cardiovascular outcomes among men with androgen deficiency. JAMA Internal Medicine 2017 Apr 1; 177(4): 491-99

Food and Drug Administration. FDA drug safety communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use.

Gagliano-Juca T, Basaria S. Testosterone replacement therapy and cardiovascular risk. Nature Reviews Cardiology 2019; 16: 555-74

Loo SY et al. Cardiovascular and cerebrovascular safety of testosterone replacement therapy among aging men with low testosterone levels: a cohort study. American Journal of Medicine 2019 Apr 3

Are Testosterone Supplements Effective?

We hear a lot in the media about how men should be worried about low testosterone levels, the symptoms that are attributed to them, and how they should consider taking testosterone replacement therapy to address those symptoms. Yet there are alternatives to this treatment approach, which is really supposed to be limited to men with diagnosed hypogonadism. So then one of the questions becomes, are testosterone supplements effective as an alternative?

What are testosterone supplements?

Unlike testosterone replacement therapy (TRT), which provides individuals with the hormone directly, testosterone supplements, which are sometimes referred to as testosterone boosters, work by increasing testosterone or related hormones. In some cases, they prevent testosterone from being transformed into estrogen. In this latter case, prevention of the conversion helps maintain T levels.

Natural testosterone supplements

Numerous herbs and nutrients have been shown to be effective as testosterone supplements. Here are those that have provided some positive research results.

D-aspartic acid

This natural amino acid has been shown to boost testosterone levels by increasing the amount of follicle-stimulating hormone and luteinizing hormone. Both of these hormones have an impact on testosterone levels. 

Other research has suggested the amino acid may play boost testosterone in certain groups of men but not others. An Australian team noted that while d-aspartic acid was associated with increases in total testosterone, it did not result in changes in resistance-trained men.

Fenugreek

You may be familiar with this herb because of its abilities to ease digestive problems, but it also can boost testosterone. Here are two studies that have demonstrated this benefit.

Sixty healthy men took either 600 mg of fenugreek or placebo daily for six week. At the study’s end, those who took fenugreek experienced an improvement in strength. The majority of men also showed increased sex drive (81% of the group), better sexual performance (66%), greater energy (81%), improved well-being (55%).

In another study of 30 college-age men, all the participants performed resistance training four times a week. Half of the men took fenugreek and the others took a placebo. Levels of both free and total testosterone rose in the fenugreek group but declined slightly in the placebo group. Men in the fenugreek group also showed a greater increase in strength and fat loss.

Ginger

Ginger has a reputation for reducing inflammation and aiding digestion, but it also has an impact on testosterone. Both animal and human studies have demonstrated this ability.

For example, several animal studies have shown that ginger increased luteinizing hormone levels in diabetic rats and can nearly double T levels. Human study results showed a 17 percent increase in testosterone levels and a nearly twofold rise in luteinizing levels in 75 infertile men who took ginger daily for three months.

Tribulus terrestris

This herb has been used for centuries by several cultures to improve sex drive and enhance testosterone levels. Research concerning the ability of the herb to boost T levels is mixed, and much of the data comes from animal studies.

However, one three-month study of men with erectile dysfunction found that the herb improved self-reported ratings of sexual health and boosted testosterone levels by 16 percent. Thus far the research indicates that tribulus can help increase testosterone in individuals who have low T or impaired sexual function, but it does not seem to increase testosterone in individuals with normal levels.

Vitamin D

A significant percentage of adults are deficient or low in vitamin D, which can have a significant impact on health. One of those effects is associated with testosterone levels. Research indicates that increasing your body’s levels of vitamin D can result in higher testosterone levels and improvements in associated symptoms.

In a year-long study of 65 men, half took 3,300 International Units of vitamin D daily, while the others took placebo. Vitamin D levels doubled in the vitamin D group and testosterone levels climbed about 20 percent when compared with the placebo group.

Zinc

Zinc is a very active mineral, involved in more than 100 chemical processes. Although the relationship between zinc and testosterone is not fully understood, what experts have shown is that men who restrict zinc intake have lower testosterone levels than do healthy men. At the same time, men deficient in zinc who take supplements show a rise in T levels.

In a 2019 study appearing in Aging Male, researchers pointed out that “medicinal doses of zinc may increase total testosterone and improve sperm count,” even though “the current body of evidene does not suggest broad recommendations regarding the use of zinc for all types of hypogonadism.”

Are testosterone supplements effective?

There are arguments on both sides of this question. In a recent study from the Keck School of Medicine of the University of Southern California, experts evaluated 150 testosterone supplements and reported that 90 percent claims to boost testosterone. However, less than 25 percent had data to support their claims.

Testosterone supplements that have scientific data to support their claims can be effective. Men need to look for products that provide such references and talk to a medical professional about how these supplements can best help them.

References

Clemesha CG et al. Testosterone boosting supplements composition and claims are not supported by the academic literature. World Journal of Men’s Health 2019 Jun 14; 37:e34

Ghlissi Z et al. Antioxidant and androgenic effects of dietary ginger on reproductive function of male diabetic rats. International Journal of Food Science and Nutrition 2013 Dec; 64(8): 974-78

Melville GW et al. The effects of d-aspartic acid supplementation in resistance-trained men over a three month training period: a randomized controlled trial. PLoS One 2017 Aug 25; 12(8): e0182630

Prasad AS. Zinc status and serum testosterone levels of healthy adults. Nutrition 1996 May; 12(5): 344-48

Santos HO, Teixeira FJ. Use of medicinal doses of zinc as a safe and efficient coadjutant in the treatment of male hypogonadism. Aging Male 2019 Feb 15:1-10

Sellandi TM et al. Clinical study of Tribulus terrestris Linn in oligozoospermia: a double blind study. Ayu 2012 Jul; 33(3): 356-64

Steels E et al. Physiological aspects of male libido enhanced by standardized Trigonella foenum-graecum extract and mineral formulation. Phytotherapy Research 2011 Sep; 25(9): 1294-300

Topo E et al. The role and molecular mechanism of D-aspartic acid in the release and synthesis of LH and testosterone in humans and rats. Reproductive Biology and Endocrinology 2009 Oct 27; 7:120

Wehr E et al. Association of vitamin D status with serum androgen levels in men. Clinical Endocrinology (Oxford) 2010 Aug; 73(2): 243-48

Wilborn C et al. Effects of a purported aromatase and 5a-reductase inhibitor on hormone profiles in college-age men. International Journal of Sports Nutrition and Exercise Medicine 2010 Dec; 20(6): 457-65

8 Top FAQs on Testosterone and Testosterone Supplements

It’s a fact of nature: testosterone levels in men decline as they get older. On average, a man’s level of this hormone peaks around age thirty and then begins to drop gradually. After age 40, levels decline by about 1.6 percent per year thereafter. That’s not a cause for gloom and doom as some commercials or men’s magazines will have you believe. In fact, many men fare quite well as their testosterone levels get lower.

However, men also should not become complacent about their declining T levels either. It’s a good idea to ask your doctor to check your T levels. A simple blood test is all it takes.

What does testosterone do?

During puberty, testosterone is the hormone that promotes the maturity of male sex organs, facial and other body hair growth, deepening voice, increasing sex drive, and denser muscle development. Throughout a man’s life testosterone plays a role in regulating sex drive, bone mass, red blood cell and sperm production, body fat distribution, erection firmness, and muscle strength, mass, and tone.

A small amount of testosterone is transformed into a form of estrogen called estradiol. As men get older and testosterone levels decline, they also produce less estradiol.

Testosterone levels rise and fall during the day. Levels are typically highest in the morning, which is when some men experience the most interest in sex.

What are some signs and symptoms of declining testosterone levels?

The signs and symptoms of declining testosterone can include things like an increase in abdominal fat, weight gain, reduction in muscle tone and strength, loss of body hair, lower sex drive, fatigue, anemia, hair loss, decline in bone density, mood changes, poor memory, erectile dysfunction, and low sperm count. Every man responds differently to his falling numbers because numerous factors are involved, including lifestyle habits (e.g., diet, exercise, sleep, stress, smoking, drug use, weight), current health status, genetics, and what is considered normal testosterone for him.

Is there a magic testosterone level below which men begin to experience noticeable signs of low T?

No. A normal, healthy testosterone level varies from man to man. Ten men with the same testosterone levels can all be at different levels of body fat, muscle strength, sex drive, and so on. A low testosterone number for you may be normal for someone else. Experts have not reached a consensus on what constitutes low testosterone.

Generally, the so-called normal range of testosterone in males is about 270 to 1,070 ng/dL, with an average level of 679 ng/dL. Some researchers, however, suggest that the healthiest testosterone levels are between 400 and 600 ng/dL.

Are testosterone supplements and testosterone replacement therapy the same thing?

No. Testosterone supplements typically are over-the-counter products that contain ingredients designed to prompt an increase in testosterone levels. They usually contain herbal or other natural ingredients (e.g., nutrients, amino acids) that can have an impact on testosterone levels. Because they are not prescription medications, testosterone supplements are not regulated by the Food and Drug Administration as drugs are. Therefore, you should look for reputable manufacturers of testosterone supplements.

Testosterone replacement therapy (TRT) consists of the hormone delivered to the body as an injection, transdermal patch, mouth patch, or gel. TRT has been approved by the Food and Drug Administration for use in men who have symptoms of low testosterone and who have verifiable low blood levels of the hormone, or hypogonadism. It is not approved for use in men who have low testosterone because of aging. 

Does testosterone replacement therapy have any side effects?

Yes. Those side effects may include:

  • Decline in sperm count, which can cause infertility
  • Higher risk of heart attack and stroke
  • Increase in breast tissue (man boobs)
  • Testicle shrinkage
  • Increased risk of blood clots
  • Acne and oily skin
  • Unwanted hair growth
  • Enlarged prostate
  • Abnormal rise in red blood cells (erthrocytosis)

In addition to these side effects, men who have certain medical conditions should talk to their doctor before starting testosterone replacement therapy. Those conditions include obstructive sleep apnea, severe urinary tract symptoms that are associated with an enlarged prostate (benign prostatic hyperplasia), elevated red blood cell counts, or severe congestive heart failure.

Besides aging, what else causes a decline in testosterone?

Several situations can cause testosterone levels to drop, either permanently or temporarily. They include:

  • Treatment for cancer
  • Injury to the testicles
  • Presence of HIV or AIDS
  • Testicular tumors
  • Pituitary disorders
  • Inflammatory conditions such as sarcoidosis or tuberculosis
  • Rigorous exercise (temporary decline)
  • Insufficient sleep
  • Too much sugar in your diet
  • Poor stress management
  • Exposure to environmental toxins, including food additives and chemicals in personal care and household cleaning products

What ingredients should I look for in a testosterone supplement?

You want a supplement that provides organic ingredients, has no added fillers, and is formulated to help restore testosterone to more natural levels. Among the natural herbs and nutrients that have been shown to have an impact on testosterone levels are beta-sitosterol, boron, fenugreek, green tea extract, magnesium, saw palmetto, stinging nettle, tongkat ali, Tribulus terrestris, vitamin D, and zinc. Look for a testosterone supplement that contains as many of these ingredients as possible.

What can I do to enhance the benefits of a testosterone supplement?

Although a high-quality testosterone supplement can greatly support testosterone levels, certain lifestyle habits can enhance the benefits. They include focusing on an all-natural food diet, getting sufficient sleep (your body needs sleep to produce testosterone), manage stress, limit alcohol, lose weight if overweight, don’t smoke, participate in both aerobic and anaerobic exercise several times a week, and avoid exposure to environmental toxins, including food additives and chemicals in personal care and household products.

References

Davis CP. High and low testosterone levels in men. MedicineNet 2019 Mar 29

MacGill M. Why do we need testosterone? MedicalNewsToday 2019 Feb 6

Tsujimura K. The relationship between testosterone deficiency and men’s health. World Journal of Men’s Health 2013 Aug; 31(2): 126-35