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Despite some heterogeneity, the majority of studies that investigated androgen levels in men with coronary disease, showed that testosterone levels were significantly lower in men with coronary disease than in matched controls. Moreover, androgen replacement therapy has positive effects on coronary risk factor profile and acts as a vasodilator demonstrating potential, because it is an anti-ischaemic agent. This means that the same behaviors that help support normal testosterone levels also promote a healthier heart. Dr. Nasir points out that only men who need the therapy should be considered for it, but it's also important to understand a man's risk of heart disease before prescribing testosterone therapy. More evidence is needed to clearly define the link between low T and heart disease, but most cardiologists agree that taking steps to keep testosterone levels healthy is important for promoting good heart health. In fact, in one study of men with heart failure, those with low testosterone had a higher risk of dying than those with normal levels.1
In a further study by the same group, the anti-ischaemic effects of testosterone therapy were demonstrated up to the end of the study period at 1 year.67Table 1 illustrates the studies investigating the effects of testosterone supplementation in men with coronary disease. The article concludes with a discussion regarding the future direction for work in this interesting area, including the relative merits of screening for, and treating hypogonadism with testosterone replacement therapy in men with heart disease. This ‘Perspectives' article reviews the current evidence regarding the cardiovascular effects of testosterone in men including an examination of the age-related decline in testosterone, the relationship between testosterone levels and coronary disease, coronary risk factors and mortality. You can stay on testosterone replacement therapy for as long as it’s benefiting your symptoms and not causing health issues. Testosterone replacement therapy can improve many of the symptoms of low testosterone (male hypogonadism). Testosterone replacement therapy (TRT) can help improve the symptoms of low testosterone due to male hypogonadism.
But recent studies suggest it’s not just about symptoms. That’s called testosterone deficiency (sometimes called hypogonadism).2 This is normal, but in some men, the drop becomes steep enough to trigger symptoms like low libido, fatigue, muscle loss, and irritability. Only a small amount (around 1–2%) circulates as "free testosterone," which is the form that’s active and available to your body’s tissues, including the heart and blood vessels.2 In the bloodstream, most testosterone is bound to a protein called SHBG (sex hormone-binding globulin).
TRT can be very important for helping teenage males with hypogonadism experience typical masculine development. A good first step is increasing activity levels and maintaining a healthy diet in order to reduce body fat. Hypogonadism in males happens when the testicles don’t produce enough testosterone. Between 19 and 39 percent of older men may have low levels of testosterone. He called the small number of patients and limited follow-up in the four studies, in some cases just weeks to months, "insufficient to identify potential risks."
They found that the beneficial effects of testosterone therapy started to become apparent after 3 months of therapy onwards. English et al.65 demonstrated similar effects, but in the context of chronic testosterone therapy. Rosano et al.39 investigated the acute effects of intravenous testosterone therapy in a group of men about to perform exercise, treadmill testing. Similar results were found in larger placebo-controlled randomized controlled trials with improvements in exercise capacity, symptom scores, VO2 max, maximal strength, insulin resistance and a reduction in electrocardiographic Q-T dispersion.74, 75, 76 Although these early studies are positive, more evaluation is needed to elucidate the mechanisms of action of testosterone in heart failure and on the long-term effects of supplementation. In a small randomized placebo controlled clinical trial, Pugh et al.73 demonstrated improvements in exercise capacity and in symptom scores after 12 weeks of testosterone therapy in men with heart failure. However, the specific relationship between testosterone and heart failure has not been studied to the same degree as that of testosterone and coronary disease. Although some people have suggested that the reported positive effects of androgens in cardiovascular disease may simply reflect non-specific effects on skeletal muscle function and mood, it has been demonstrated that testosterone does have direct vaso-active effects.
Studies in male animals have shown accelerated atherosclerosis after castration—an effect that is abrogated by androgen replacement therapy.43, 44 The same study demonstrated a prevalence of hypogonadism of 24% in men with coronary artery disease, by strict criteria, which is approximately three times higher than the expected background rate. Bioavailable testosterone assays have been utilized in several studies of men with coronary artery disease and more consistently demonstrate decline with age. It is widely regarded that men display behaviours which are considered, cardiologically, more risky with increased levels of smoking and with diets richer in saturated fats.2 However, multiple logistic regression analysis has shown that differences in behavioural profiles do not account for the excess burden of coronary disease in men.2, 26 The development and progression of coronary atherosclerosis is heavily influenced by the interaction of multiple risk factors. Studies of men who abuse anabolic steroids have clearly demonstrated higher risk of myocardial infarction and sudden cardiac death.10, 11, 12 In men, exogenous oestrogen therapy has also been trialled for secondary prevention of coronary disease, following acute myocardial infarction.13 This trial was terminated early due to a twofold increase in re-infarction and a significant increase in mortality. "The trial did find, however, that arrhythmia risk may be slightly higher while on testosterone replacement, which has implications for how we think about treating testosterone deficiency." And what should we make of the warnings that testosterone therapy might actually negatively impact the heart?
Just being tired isn't enough to seek testosterone replacement therapy. Testosterone therapy may make sense for women who have low testosterone levels and symptoms that might be due to testosterone deficiency. However, many men with normal testosterone levels have similar symptoms, so a direct connection between testosterone levels and symptoms is not always clear. This means that there may be a huge population of men with symptomatic hypogonadism that would benefit from replacement therapy, not only from a symptomatic and endocrine perspective, but also from improved cardiovascular outcomes.
Even with an abnormally low level that is replicated on a repeat test, the decision to begin testosterone replacement therapy and the proper dose requires a careful conversation with your doctor. Studies estimate the prevalence of symptomatic hypogonadism in men with coronary disease at approximately one-quarter (24%) and that these men have poorer cardiovascular outcomes than those with normal androgen levels. However, it has now been demonstrated in several large longitudinal cohort studies of men with and without coronary disease that low baseline testosterone is a significant risk marker of increased all-cause and cardiovascular mortality. Our view is that this study showed that men with hypogonadism should be treated only with physiological doses of testosterone for true replacement therapy. Despite historical concerns over testosterone therapy in aging males, there is now a large and rapidly increasing body of evidence suggesting that testosterone replenishment in men with cardiovascular disease is safe and effective.
After age 30, notes Dr. Nasir, there's a steady decline in testosterone levels, about 1%-2% per year. "It can even be considered a risk factor for heart disease." But there are many reasons for a man to care about a decline in his testosterone levels. Testosterone is a metabolic hormone with far-reaching effects, including on your heart. After around age 40, testosterone levels begin to decline slowly but steadily. - https://git.cultist.gay/sidneylemessur
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