Make an informed decision about your Testosterone Therapy. The results of a recently released study have flaws, healthy testosterone levels are actually vital for men’s heart health.
In November of 2013, the Journal of the American Medical Association (JAMA) published a fundamentally flawed study that has generated a lot of media attention and caused concern among men interested in treating their andropause symptoms with testosterone therapy.
The study, which was conducted by Rebecca Vigan et al within the Veterans Affairs (VA) system, claims to have found a link between Testosterone Replacement Therapy (TRT) and a 29% increase in risk of stroke, heart attack, and death in men 60 and over.
The truth is that if done correctly, restoring testosterone to healthy levels actually supports heart health in men. The study’s results can only be applied to irresponsible and unsafe treatment programs. Read on to discover why the study’s findings do not tell the entire story.
Flaws In Vigan’s Study
When subjected to close scrutiny, the results of Vigan’s study fall into question. Flaws in the description of the patient sample and in treatment standards make it impossible to compare the study’s subjects accurately to one another, or to patients undergoing a quality TRT program.
The following are just a few of the problems with the study’s patient sample:
- 93% of the patients included in the study were already confirmed high-risk patients by cardiology standards.
- 20% already had a history of heart attack.
- 18% had a history of congestive heart failure.
- 55% already had coronary artery disease as confirmed by an angiogram.
- There was also a statistically significant difference in baseline testosterone levels between treatment and control groups. Average baseline testosterone levels were higher in the control group than in the therapy group. This disparity was large enough to skew the study’s results.
When this study’s results are reported in the media, the fact that almost every study participant was already at high risk for a cardiac event was usually ignored. The result has been the false impression that the study proves an increase in risk for all men over age 60 who are undergoing testosterone replacement therapy.
Treatment Standards That Were Either Missing Or Flawed
Another serious problem with Vigan’s study is its failure to establish any clearly documented, safe, and effective treatment protocol for the testosterone therapy provided to the study’s participants. The following flaws in the administration of therapy call the study’s findings into question:
- There was no single method of delivery chosen. Some participants were given testosterone patches, others gels, and still others injections, making it impossible to compare results among participants.
- Only 60% of participants had blood levels checked after beginning treatment, and not a single one of the patients checked reached an optimum level of between 800 and 1200ng/dl for their total testosterone. The average total testosterone level among participants was just 332.3ng/dl—far from what would be considered adequate for a quality TRT program.
- Estrogen levels were not monitored, nor controlled by way of an estrogen blocker. Meanwhile, elevated estrogen can cause abnormal clot formations, and increase the risk of stroke.
- Hematocrit levels were neither monitored nor managed. In some men, testosterone replacement can increase hematocrit levels in the blood. If not managed, elevated hematocrit levels can increase the risk for stroke.
- No other hormones (like DHEA and thyroid) were measured or taken into consideration during the study, as would have been done in a quality TRT program.
By failing to address estrogen and hematocrit levels, Vigan and her associates not only put the study’s participants at risk, but also severely limited the scope of its conclusions. In short, the study’s results can only be applied to irresponsible and unsafe treatment programs that do not address estrogen and hematocrit levels nor increase testosterone to healthy levels.
Here We Go Again…
On January 31st 2014, the results of a study conducted by Finkle et al and published in the journal Plos One claimed findings similar to the above. But Finkle’s study has similar flaws, namely that estrogen and hematocrit levels were neither checked nor controlled.
In addition to the same flaws listed previously, the study’s authors compared the men receiving testosterone therapy to a separate group of men (their control group) who were started on PDE5 inhibitors (e.g. Viagra). The authors’ rationale was that by putting the control group on PDE5 inhibitors there would be comparable increase in sexual activity across the two groups. The problem is that PDE5 inhibitors are known to have a significant positive effect on the cardiovascular system, including a decrease in the risk of heart disease as well as the ability to relax blood vessels in men who already have heart disease. This all begs the question: how can the results of their study warrant any credence when their findings hinge on this particular control group?
The Truth And The Science Behind Quality Testosterone Replacement Protocols
The truth is that low testosterone presents significant cardiac risk factors in and of itself, as does elevated estrogen. Meanwhile, quality testosterone treatment that includes control of estrogen and hematocrit levels can actually decrease cardiac risk. Numerous reputable studies conducted over the past 30+ years have proven this. The following is a sampling of relevant studies and their conclusions:
Low Serum Testosterone and Mortality in Older Men
In December of 2013 the Journal of the American Heart Association reviewed over 150 research studies to assess the connection between testosterone and cardiovascular disease. The authors concluded that low testosterone is associated with increased rates of mortality, including cardiovascular-related mortality. The severity of disease correlated with the degree of deficiency.
(Peyman Mesbah Oskui M.D. et al. Testosterone and the Cardiovascular System: A Comprehensive Review of the Clinical Literature. Journal of the American Heart Association 2013)
Testosterone treatment resulted in a 39 percent decreased mortality risk vs. men not treated with testosterone.
(Shores MM et al. Testosterone treatment and mortality in men with low testosterone levels. Journal of Clinical Endocrinology and Metabolism 2012)
Men with testosterone levels in the lowest quartile of sample were 40 percent more likely to die than those with higher levels. In this study, low testosterone also predicted increased risk of cardiovascular disease.
(Gail A. Laughlin et al. Low Serum Testosterone and Mortality in Older Men. Journal of Clinical Endocrinology and Metabolism 2007)
Testosterone improves coronary artery blood-flow.
(Chou TW, Circulation, 1996, 94: 2614)
Healthy testosterone levels lower risk factors for coronary heart disease.
(Phillips GB et al. The association of hypotestosteronemia with coronary artery disease in men. Arterioscler Thromb. 1994 May;14(5):701-6 Department of Medicine, Columbia University College of Physicians and Surgeons,St. Luke’s-Roosevelt Hospital Center, New York, NY)
Elevated estrogen has the following impacts:
- Elevated triglycerides and LDL cholesterol
- Lowered HDL cholesterol
- Elevated blood coagulation & platelet aggregation
- Lowered ratio of testosterone/estrogens
- Elevated arterial hypertension
- Lowered blood circulation to the brain
(Portnoi AS et al, Urol Nefrol Mosk, 1992, 1-39: 6-11)
Healthy heart tissue has a 2.5 x higher testosterone concentration than skeletal muscles.
(Krieg M et al. Demonstration of a specific androgen receptor in rat heart muscle: relationship between binding, metabolism, and tissue levels of androgens. Endocrinology. 1978 Nov;103(5)
Low T linked to Hyperlipidemia (high cholesterol) and glucose intolerance (pre-diabetic).
(Gerald B, Am J Medicine, 1978, 65: 7-11)
Elevated estrogen in males increases the risk of coronary insufficiency & myocardial infarct.
(Entrican JH et al, Lancet, 1978, Sept, 487-90)
Don’t Let Sensational Media Headlines Scare You. Make an informed decision based on the facts and what’s best for your health.
Achieving healthy testosterone levels through a properly designed and executed treatment plan has clear cardiovascular benefits. And don’t forget about your quality of life. Men feel better when their testosterone levels are healthy.
Want to know more? Contact Renew Man at 800-859-7511.