If You Don’t Have Enough; Health Will Suffer And You are Wasting Your Time In the Gym!
As hormone replacement therapy (HRT) has become much more common place, and there is a growing understanding that keeping men in the “healthy” range for testosterone (T) has various benefits, I wanted to briefly address the issue. For those who need a refresher on the basics of blood work, see my article “It’s In Your Blood”
To review the general issues of low T in men, according to one recent review by a Dr. Shabsigh and colleagues:
“Hypogonadism (low testosterone) is associated with central obesity; insulin resistance; low levels of high-density lipoprotein (HDL); high cholesterol levels; and high levels of low-density lipoprotein (LDL), triglycerides, fibrinogen, and plasminogen activator-1. Some observational studies show a correlation between low testosterone and cardiovascular disease (CVD), and others show no correlation. Interventional studies do not reveal a direct long-term relation between testosterone therapy and CVD. Short-term data suggest cardiovascular benefits of testosterone.”•
The above review also leaves out other known effects of low T, such as loss of libido, depression, loss of muscle mass and decreases performance, as well as other issues best avoided.
Most studies find clear health benefits for men with hypogonadism treated with HRT. However, some fears of long term side effects such as cardio vascular disease (CVD) and prostate cancer have been raised. These fears appear to be unfounded, with benefits to the cardio vascular system for men low in T.
So what of the risks of CVD or prostate cancer with HRT?
The jury is still out, but most data does not find an association between HRT and CVD or prostate cancer. For example, a retrospective analysis by researchers at Beth Israel Deaconess Medical Center published in The New England Journal of Medicine found no causal relationship between testosterone replacement and prostate cancer or heart disease risk. According to Dr. Abraham Morgentaler:
“We reviewed decades of research and found no compelling evidence that testosterone replacement therapy increases the incidence of prostate cancer or cardiovascular disease.”••
This review of 72 studies puts to rest-at least for me- that there is any risk of testosterone replacement therapy, at least where it concerns CVD or prostate cancer. Not everyone would agree with that opinion however and anyone considering HRT should get full blood workup done and talk with their doctor about it.
But what about healthy men with normal testosterone levels taking additional testosterone? That’s a little less clear at this time. Studies are conflicting whether or not adding additional testosterone to men with normal levels presents an increased risk. However, a study published in The New England Journal of Medicine (NEJM) – considered one of the most prestigious medical and scientific journals in the world – found healthy men given 600mg per week of testosterone enanthate did not suffer any side effects, negative changes in lipid profiles, and did not see a rise in prostate-specific antigens, or increased aggression. •••
But what if the person has already had a heart attack? Interestingly, one study suggests testosterone therapy may actually help after a heart attack, but it’s preliminary research done on animals. ••••
This is just a sample of the many studies published on the topic. Finally, what about the very high doses used by high level bodybuilders and other athletes? That’s petty much an unknown at this time. As with many hormones, below a certain levels, health issues arise and above a certain level, the same thing happens, though the health issues may or may not be the same. For example, very high levels or very low levels of T may present an increased risk for cardiovascular disease (CVD) but far more is known about too little vs. too much when it comes to testosterone and CVD or prostate issues, etc. At the very high doses used by some athletes it would not surprise me if there was an increased risk of CVD but data is scarce here. So what’s the take home?
• For men with low testosterone, studies are quite clear the benefit of HRT outweigh the risks by a long shot.
• In men with normal testosterone who take moderate doses (defined here as 600mg per week or less), there appears to be little risk, at least in the short term. Other side effects, such as acne, hair loss (if genetically susceptible) and others are still possible however and should not be ignored
• In bodybuilders and other athletes taking very high doses, say above 1000mg per week or more, the risks are unclear and not recommended without very close medical supervision, especially if other risk factors are involved, such as a family history of CVD, etc.
That pretty much sums up my thoughts on the issue.
• Cardiovascular issues in hypogonadism and testosterone therapy.Am J Cardiol. 2005 Dec 26;96(12B):67M-72M.
••• “The Effects Of Supraphysiologic Doses Of Testosterone On Muscle Size And Strength In Normal Men (vol.336, July, 96).
•••• Cardiovasc Res. 2003 Feb;57(2):370-8.
Effect of testosterone on post-myocardial infarction remodeling and function. Cardiovasc Res. 2003 Feb;57(2):370-8