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OPTIMIZE YOUR HEALTH Testosterone: Good for Men’s Heart
Health & Metabolism The previous view that testosterone is the culprit of the higher prevalence of coronary heart disease in men — as compared to premenopausal women — may have been totally erroneous! In fact, testosterone is beneficial to men’s cardiovascular health. This is welcoming news to the many men who have hypogonadism (testosterone deficiency). It is estimated that of men aged 45 and older, about 13 million may have low testosterone, of which as many as 90 percent may remain untreated. That could be because many men are unlikely to seek medical attention for fatigue, sexual dysfunction, or depressed mood — some of the more common signs and symptoms of hypogonadism. Hypogonadism, defined by low testosterone levels in men, is a complex syndrome. According to the AACE Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hypgonadism in Adult Male Patients, the recognition, evaluation, and treatment of hypogonadism in the male patient are often dismissed by the patient and overlooked by the physician. Signs and Symptoms of testosterone deficiency include:
Testosterone replacement therapy can often enable the patient to function in a more normal manner and decrease the risk of future problems with sexual function / fertility, mood disturbances, cardiovascular disease and osteoporosis. Testosterone Deficiency Increases Diabetes and Cardiovascular Risk Men with a history of diabetes, hypertension or hyperlipidemia have a higher prevalence of hypogonadism, according to research issued at the American Association of Clinical Endocrinologists (AACE) 2005 Annual Meeting and Clinical Congress. Of the 2,162 men in the study, prevalence rate of hypogonadism was 50 percent for those with diabetes, 42 percent those with hypertension and 40 percent for those with hyperlipidemia. Another study showed the prevalence of testosterone deficiency was already increased in men with prediabetes. Male relatives of diabetic patients had lower plasma total testosterone levels as compared to the male normal controls. Studies suggest that low testosterone levels in men may potentially be a contributory factor to the development of insulin resistance and the subsequent progression to type 2 diabetes. Lower levels of testosterone in men have been associated with a proatherogenic lipid profile, hypertension, a prothrombotic profile and a proinflammatory state. Increased arterial stiffness has been found in men rendered hypogonadal by hormonal treatment for prostate cancer. Testosterone Deficiency and Increased Waistline – A Vicious Cycle Studies have shown that free testosterone levels are low in obese individuals. During the hypogonadal state, there is an increase in deposition of abdominal adipose tissue. Adipose tissues possess an aromatase enzyme, which changes testosterone into estrogen. The increase in abdominal adipose tissue results in increased aromatase activity leading to a greater transformation of testosterone into estrogens. This leads to a further reduction in serum and tissue testosterone concentrations, increased deposition of abdominal fat and progressive hypogonadism. The good news is that changes in total and free testosterone concentrations are reversible with weight loss. The increases in plasma free and total testosterone levels are proportional to the degree of weight loss. Testosterone is Good for Men’s Heart Health Physiological testosterone replacement in hypogonadal men has been shown to reduce total and LDL cholesterol. Testosterone replacement has been shown to suppress proinflammatory cytokines interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) and to increase levels of IL-10, which has protective effect against atherosclerosis. Testosterone replacement also produced a modest reduction in diastolic blood pressure of about 5 mmHg in one study. Testosterone is found to be a vasodilator in coronary arteries and other blood vessels throughout the body to help increase blood flow. Bottom Line Hypogonadism is a common and under-recognized condition, which negatively impacts on the quality of life of men as well as their loved ones. The good news is that testosterone replacement therapy when used appropriately not only can help restore vitality and sexual health but can also reduce the risk for diabetes, cardiovascular disease as well as osteoporosis. As an endocrinologist, I have expertise in diagnosis and treatment of testosterone deficiency. Along with my endocrinology nurse practitioner Sue Kim-Saechao, we evaluate and treat each man presenting to The Center for Optimal Health with a whole-person approach, utilizing our integrative healthcare team. Please see Sue’s article for more details about our comprehensive evaluation process. Download the ADAM Questionnaire (PDF) to find out whether you may have low testosterone. —June 2006
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