Archive for the ‘heart attack’ Category

Testosterone Replacement-Relationship With Heart Disease

March 27, 2017

Much has been written about the use of testosterone in men with symptoms of low T and documented low levels of testosterone.  One of the issues is the use of testosterone replacement therapy and its impact on cardiovascular health.

First, there have been documented trials that demonstrated clinically improvements in bone density and low blood count or anemia.  Another recent study demonstrated an impressive reduction in cardiovascular events such as heart attack and stroke in men taking testosterone for low T levels.

A two year study was conducted comparing testosterone replacement therapy using topical gels containing testosterone to placebo that had gel only and no testosterone. At one year after starting the study, there were no heart attacks, strokes, or deaths in either group. At two years there were more heart attacks and strokes in the placebo group (nine events for placebo versus two events for testosterone).  The study concluded that testosterone replacement may be cardioprotective or can protect your heart.

A key additional finding was significant improvement in bone density and strength in men treated with testosterone.

Bottom Line:  These new, exciting results provide even more evidence to support the importance of using testosterone replacement therapy in men with low levels of testosterone and who are symptomatic from their decrease in testosterone levels.

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50 Shades of Sex In the Golden Years

February 24, 2015

So many seniors think that after sixty sexual intimacy goes into the tank. This is hardly the case as an interest in intimacy and sexual activity continues throughout life even in the golden years. Our society tends to have ageist concept of intimacy, portraying sex among seniors as inappropriate or unnatural. The truth is that many seniors, both men and women, continue to be sexually active and are interested in meeting others with whom they can become intimate. There is documentation that 70% of men and 35% of women continue to be sexually active over the age of 70. This blog will discuss sex and the senior and what you can do if you are having problems with sexual intimacy in your senior years.

While most long-married individuals reported steady declines in sexual activity, those who passed the 50-year marriage mark began to report a slight increase in their sex lives.

And notably, frequency in the sex lives of long-married couples continued to improve. The study, published last month in The Archives of Sexual Behavior, researchers noted that an individual married for 50 years will have somewhat less sex than an individual married for 65 years.

The analysis of this study showed that the warm glow after the 50-year marriage mark, although flickering, was steadier than that of those in marriages of shorter duration. The researchers are sociologists at Louisiana State University, Florida State University and Baylor University.

Sexual frequency doesn’t return to two to three times a month, but it moves in that direction, which was reported by the investigator from LSU.

But the finding that some long-married couples continue to have sex decade after decade was not news to Jennie B., an 82-year-old widow who lives in a village in upstate New York. She married her first and only husband, Peter, in 1956, when they were in their mid-twenties. The couple, married 47 years, remained sexually active until he had quintuple heart bypass surgery two years before his death in 2003.

In this snapshot study of older adults, some were not having sex at all. And a few were even having sex daily. But in the main, the study looked at trends. The average older adult who had been married for a year had a 65 percent chance of having sex two to three times a month or more. At 25 years of marriage, the likelihood of that frequency dropped to 40 percent. If the marriage lasted 50 years, the likelihood was 35 percent. But if the marriage — and the lifespan — of the older adults continued, at 65 years of being together, the chance of having sex with that frequency was 42 percent.

And so, as adults age, their social circles shrink, they know time is limited, they look around and what do they see? Each other. Seniors will often place intimacy as a high priority.

I might add that seniors often engage in intimacy without having intercourse but that intimacy can occur with touching, holding hands and kissing is often just as satisfying and gratifying as sexual intercourse which occurs at an earlier age.

Bottom Line: Sex after sixty is an activity that is normal and should be encouraged. It may take a little creativity and it may take a little more planning and effort but it can happen and both partners feel a sense of enjoyment and pleasure.

Recommended Reading 30 Lessons for Loving, by Karl Pillemer, PhD.

Perhaps even 50 Shades of Grey!

A Walk A Day, and Not An Apple, Keeps the Doctor Away

February 10, 2015

The baby boomers have arrived in large numbers. They are taking responsibility for their health and are eager to stay well and out of the doctor’s office. This blog will discuss the importance of exercise, even walking, to make you healthy and well. This blog will emphasize exercise and not weight loss as the road to good health and longevity.

A brisk 20 minute walk each day could be enough to reduce your risk of early death. A study of over 334,000 European men and women found that twice as many deaths may be attributable to lack of physical activity compared with the number of deaths attributable to obesity, but that just a modest increase in physical activity could have significant health benefits.
Physical inactivity has been consistently associated with an increased risk of early death, as well as being associated with a greater risk of diseases such as heart disease and cancer. Although it may also contribute to an increased body mass index (BMI) and obesity, the association with early death is independent of an individual’s BMI.
To measure the link between physical inactivity and premature death, and its interaction with obesity, researchers analyzed data from 334,161 men and women across Europe participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study. Over an average of 12 years, the researchers measured height, weight and waist circumference, and used self-assessment to measure levels of physical activity. The results are published today in the American Journal of Clinical Nutrition.

TThe authors estimate that doing exercise equivalent to just a 20 minute brisk walk each day — burning between 90 and 110 kcal (‘calories’) — would take an individual from the inactive to moderately inactive group and reduce their risk of premature death by between 16-30%. The impact was greatest amongst normal weight individuals, but even those with higher BMI or with obesity saw a benefit.
Using the most recent available data on deaths in Europe the researchers estimate that 337,000 of the 9.2 million deaths amongst European men and women were attributable to obesity (classed as a BMI greater than 30): however, double this number of deaths (676,000) could be attributed to physical inactivity.

Bottom Line: So what is the message? This is a simple message: just a small amount of physical activity each day could have substantial health benefits for people who are physically inactive. Although we found that just 20 minutes would make a difference. Physical activity has many proven health benefits and should be an important part of our daily life.

Story Source:

Journal Reference:
1. Ulf Ekelund, Heather A Ward, Teresa Norat, Jian’an Luan, Anne M May, Elisabete Weiderpass, Stephen S Sharp, Kim Overvad, Jane Nautrup Østergaard, Anne Tjønneland, Nina Føns Johnsen, Sylvie Mesrine, Agnès Fournier, Guy Fagherazzi, Antonia Trichopoulou, Pagona Lagiou, Dimitrios Trichopoulos, Kuanrong Li, Rudolf Kaaks, Pietro Ferrari, Idlir Licaj, Mazda Jenab, Manuela Bergmann, Heiner Boeing, Domenico Palli, Sabina Sieri, Salvatore Panico, Rosario Tumino, Paolo Vineis, Petra H Peeters, Evelyn Monnikhof, H Bas Bueno-de-Mesquita, J Ramón Quirós, Antonio Agudo, María-José Sánchez, José María Huerta, Eva Ardanaz, Larraitz Arriola, Bo Hedblad, Elisabet Wirfält, Malin Sund, Mattias Johansson, Timothy J Key, Ruth C Travis, Kay-Tee Khaw, Søren Brage, Nicholas J Wareham, and Elio Riboli. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). Am J Clin Nutr, January 14, 2015 DOI: 10.3945/ajcn.114.100065

Why Sex Is Good For You?

December 27, 2014

Sexual intimacy has been associated with having a heart attack, contacting a sexually transmitted disease (STD) or having an unplanned pregnancy. However there are some significant health benefits for engaging in regular sex.

Immune Boosting

Eating well, getting enough sleep, and getting vaccinated are all important in boosting your immune system. Add regular sex to these and you have a great immune system that defends your body against infective organisms. This is because research has shown that those that are sexually active had a higher blood level of certain antibodies than those that were not so active sexually and these antibodies help you fend off infections.

Bladder control for women

About 30% of women will have urinary incontinence at one time or the other in their lives. This is when a person passes urine without intending to. Studies have shown that women who had sex regularly were less likely to develop urinary incontinence as sex helps strengthen their pelvic muscles which is important for bladder control.

Lowers Blood Pressure

People who had more sex have been found to have a lower blood pressure compared to others, ensuring that they stay healthy. One study found that those who regularly had sex had a lower blood pressure compared to those who did not.

Sex is good exercise

It’s been found that on the average, you burn about five calories per minute while having sex. This can be a good source of exercise for those that hardly have time to exercise. The benefits of exercise are quite numerous and sex delivers some of those benefits. For a reference, jogging one mile burns about 100 calories.

Reduces Risk for Heart Attack

Men who had sex regularly were found to have a 50% lesser risk of developing a heart attack. This is not only because it raises your heart rate which is great; it also keeps your sex hormone, estrogen and testosterone, in balance which are important hormones and their balance can help avoid conditions such as osteoporosis and heart disease.

Better Sleep

You may have noticed that you sleep better after sex. This is because the hormone prolactin and melatonin is usually released after an orgasm. This hormone helps with relaxation and the feeling of sleepiness.

Reduces Stress

The arousal associated with sex is great in easing stress. This is because your brain releases some chemicals that help in exciting your entire body. Sex can also help stimulate happiness and boosts self-esteem.

Reduces Pain

Sex can help reduce the feeling of pain. Sex helps release a hormone, endorphins, which are much more potent than morphine, that usually raises your pain threshold. Sexual stimulation can combat chronic pain such as the pain associated with arthritis.

Bottom Line: Sexual intimacy is a healthy activity for consenting adults. This blog provides many of the reasons to engage in sexual activity.

ED or Impotence May Be Sending A Message To Your Heart and Brain

October 22, 2014

Having trouble with your erections? You are not alone as nearly 30 million American men suffer from this problem. That’s the bad news. The good news is that erectile dysfunction or ED may be harbinger of something more ominous that may affect your health and well-being. This blog will discuss the connection between ED and heart disease.

No man wants to be diagnosed with erectile dysfunction (ED), but believe it or not, it could save your life. In many cases, ED is a precursor to cardiovascular disease and when diagnosed properly could reduce the chance of having a heart attack or stroke.

ED is the inability to obtain or sustain an erection. It is extremely common, affecting more than half of men over 60. Given our rising rates of obesity and sedentary lifestyles, there is a good chance that performance in the bedroom is not about emotional issues or the male anatomy itself. It may sound strange but the penis is the barometer of a man’s overall health.

You can imagine how a heart artery gets clogged in a person with high blood pressure, high cholesterol or diabetes. When that coronary artery, which measures around 1\8 inch, gets obstructed that little to no blood flows through it, that man is going to experience chest pain (angina) or a heart attack. The same holds true for the carotid arteries, which measure 1\2 inch and take blood up to the brain. When the carotid artery gets blocked, that man will experience symptoms of a stroke. Now imagine the tiny penile artery, measuring only 1\16 inch. Its smaller diameter makes it ultra-sensitive to blockages, resulting in erectile dysfunction the penile artery becomes blocked.

Our entire vascular system is connected and the same things that harm our big blood vessels to our heart and brain will affect our smallest ones as well. The common cause of all this is what’s called atherosclerosis. As the same systemic process takes place throughout our vascular system, it’s these small arteries in the penis that will feel the effects earlier and manifest the symptoms of ED before other organs such as a man’s heart or brain start to suffer.

A lack of erections or difficulty holding an erection may be one of the earliest signs of impending heart disease or a stroke. When a man experiences ED this should an alarm should for men, their partners and their doctors. It’s important to realize that ED and cardiovascular disease have the same risk factors. These include high blood pressure, diabetes, high cholesterol, smoking and excess weight. Realize, too, that all these risk factors are modifiable, meaning you can actually improve them to reverse or halt the damage that is being done.

The message is: the recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise. Studies show that men presenting with only mild ED have a significant amount of undiagnosed high blood pressure, high blood sugar and high cholesterol, among other things. This is why men with mild ED, particularly if they are younger than 50, need to be screened for cardiovascular risk factors and have those risks treated aggressively. This means a visit to a doctor, having an EKG, and a stress test to see if there any decrease in blood supply to the heart.

We’ve come a long way since the days when ED was something men kept to themselves, too embarrassed to discuss with their friends or doctor. The introduction of pills (Viagra, Cialis, Levitra) to treat ED over 15 years ago opened the door for conversations about the condition.

The good news that lifestyle changes to modify risk factors, such as high blood pressure, elevated cholesterol level, obesity, and diabetes, that will provide the greatest benefit to a man’s overall health, not just his penis.

Bottom Line: ED can be a harbinger of impending heart disease or stroke. Don’t dismiss difficulty getting or holding an erection as this may indicate a future heart attack or stroke. See you doctor or urologist.

Recent Study Does Not Indicate Testosterone Use Doesn’t Increase Heart Risk

July 7, 2014

A few months ago an article appeared in the Journal of the American Medical Association (JAMA) that implicated testosterone as a cause of heart disease and stroke. But critics including several hundred physicians have attacked the study noting that among other things, the study including over 100 women among the 1,132 subjects studied. Over 25 international medical groups have demanded that JAMA retract the article.

A new study now points out that testosterone therapy didn’t increase the risk of heart attack, contrary to the JAMA study, and that it even lowered the risk of heart attack by about 30%.
In the latest study, published online in the Annals of Pharmacotherapy, researchers at the University of Texas Medical Branch used a national Medicare sample and compared the records of 6,355 men who had at least one testosterone injection between 1997 and 2005, with 19,065 non-testosterone users. The testosterone users were no more likely to have a myocardial infarction than the nonusers during the period, according to the study.

The researchers also ranked the subjects based on their predicted risk of heart attack for other reasons. For men in the quarter with the highest risk, the use of testosterone cut that risk by roughly 30%.

The latest study only at men receiving testosterone injections, not those using pills, patches or gels, and couldn’t assess what other medications the men were taking. Men typically lose testosterone as they age, and some conditions can cause a steep drop in levels earlier, leading to osteoporosis which increases the risk of hip and spine fractures, sexual dysfunction, loss of muscle tone, fatigue, diabetes and other health problems. Proponents say restoring normal levels can alleviate those issues.

Bottom Line: Testosterone deficiency or low T affects millions of American men. The diagnosis is easily made with a history of decreased libido, decreased sexual performance, loss of muscle mass and loss of energy or fatigue. The diagnosis is easily made with a simple blood test and can be helped with testosterone replacement therapy. For more information on testosterone deficiency speak to your doctor.

What You Need To Know About Low T (Testosterone) and Heart Disease

March 27, 2014

I have received dozens of calls from men who are concerned about the recent study that reports that testosterone replacement therapy increases the risk of heart attacks and strokes. This blog is intended to clarify some of the misinformation that is attracting so much media attention. The Androgen Study Group, a large group of physicians and researchers of which I am a member, is calling for the retraction of the paper that appeared in the Journal of American Medical Association linking testosterone and cardiovascular risks — data that its authors of the paper in the journal are standing firmly behind.

In a letter to Howard Bauchner, MD, editor-in-chief of the Journal of the American Medical Association, members of the group — formed in response to the paper and comprised of more than 125 doctors — said the study’s credibility was compromised by at least two corrections and should be pulled from the journal.
A close friend and colleague, Dr. Abraham Morgentalker pointed out the there’s no misconduct, no one faked any data, it’s just sloppy. The group called it “gross data mismanagement.”

The paper, published in JAMA in November by Michael Ho, MD, PhD, of the Eastern Colorado VA, and colleagues, found that testosterone therapy was associated with a greater risk of death, heart attack, and stroke in male veterans who’d had coronary angiography. (If the men were having coronary angiography, it stands to reason that they already had some heart disease or they wouldn’t have been subjected to this invasive procedure)

But two corrections have since been published. The first, in the Jan. 15 issue, was a clarification that the results were based on “estimates” and not raw data.

The second, which Morgentaler and colleagues focus on in their letter to the editor of the journal, involved reclassivication of patient who were excluded from the study. More than 1,000 excluded patients were assigned to different categories of exclusion, including 100 who were women!

The authors included almost 10% women in an all-male study, so why should we believe any of the other data? The Androgen Study Group points out that the data were so off that it’s hard to believe the data for the entire study are accurate.

However, Ho and colleagues said they “stand firmly by the results of our study,” noting that the overall number of excluded patients remains the same, as does the total number of included patients, and the main results of the study were not changed.

The study group said that these claims run contrary to 40 years’ worth of research on testosterone, which suggests that the hormone has some beneficial effects in certain heart patients.

But the testosterone therapy field has garnered much media attention for its financial relationships with industry. Several articles in the New York Times, including one on the marketing of “Low T”, another on the selling of testosterone gels, and an editorial, have questioned the potential overselling of the therapy.

It is true that several members of the Androgen Study Group, myself included, have relationships with testosterone drug makers, such as AbbVie, Watson, and Endo Pharmaceuticals.

It is my opinion that men who are symptomatic for low testosterone and have complaints such as lethargy, decreased libido, loss of muscle mass, and decrease in erections or potency AND who have a documented decrease in the blood level of testosterone, are good candidates for hormone replacement therapy. These men who are going to receive testosterone should have a normal digital rectal exam and a normal PSA test if they are less than 75 years of age.

Bottom Line: Low testosterone has effects that impact a man’s quality of life. If a man has symptoms of low T and a documented decrease in the blood testosterone level, he should speak to his physician about testosterone replacement therapy.

Testosterone and Heart Disease – Facts & Caveats

January 30, 2014

I have received numerous calls from men who have symptoms of low testosterone, a documented decrease in their serum testosterone level, and who are receiving testosterone replacement therapy regarding a study that recently appeared in PLOS One.*

Let’s look at some facts. The human body is always trying to achieve homeostasis which is defined as “the ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes.” What does this mean? It means that the body is always trying to stay normal without deviations from the norm. For example, if a man drinks too much water, the kidneys will increase the excretion of water. If a man is dehydrated, the kidneys will try and conserve water to prevent the problems associated with dehydration. If a man has diabetes, the doctor will recommend a treatment to lower the blood sugar. If a man has high blood pressure, the doctor will recommend dietary changes, exercise, and perhaps medication to lower the blood pressure. If a man has anemia or a low blood count because of iron deficiency, the doctor will prescribe iron supplements. If a man has a deficiency in vitamin D, the doctor will recommend increasing the consumption of this necessary vitamin. These actions are what we do every day; we attempt to achieve a normal equilibrium in the body as this is the best way to restore and maintain health.

This same reasoning applies to men who are deficient in testosterone. Testosterone is a necessary hormone produced in the testicles that is responsible for a man’s sex drive, muscle mass, energy level, bone strength, and even a man’s mood which may cause depression if the hormone is low and not returned to normal. The unstudied/published issue is what is the target value? Most experts feel that there is no absolute “correct” value, but rather treatment is targeted at relief of symptoms.

There are more than 13 million men in the United States who reportedly suffer from testosterone deficiency. For men who receive treatment, they usually report significant improvement in their symptoms. There are many conflicting reports about testosterone and heart disease. There are even studies that support that low testosterone increases the risk of heart disease and that treating the deficiency with hormone replacement therapy may be protective of heart disease.

The study recently reported a study of the risk of acute non-fatal myocardial infarction (MI) following an initial TT prescription (N = 55,593) in a large health-care database. We compared the incidence rate of MI in the 90 days following the initial prescription (post-prescription interval) with the rate in the one year prior to the initial prescription (pre-prescription interval) (post/pre).
The results of this study in all subjects revealed the rate ratio (RR) for TT prescription was 1.36. In men aged 65 years and older, the RR was 2.19 for TT prescription. The RR for TT prescription increased with age from 0.95 for men under age 55 years to 3.43 for those aged ≥75 years. In men under age 65 years, excess risk was confined to those with a prior history of heart disease.
The study summary stated that in older men, and in younger men with pre-existing diagnosed heart disease, the risk of MI following initiation of TT prescription is substantially increased.

Some comments about the study:

No follow-up or research was done on whether or not the men on testosterone therapy achieved therapeutic levels or if they stayed on treatment. It is not accurate to assume that all men treated had their testosterone levels elevated by therapy.

There is no documentation as to whether or not Endocrine Association guidelines were followed, including morning testosterone level assessments and repeating the test at least once.

In closing, a larger study in the Journal of Clinical Endocrinology and Metabolism showed that among male veterans over 40, those on testosterone had lower rates of death than those that did not. This certainly makes sense, since hypogonadism is associated with metabolic syndrome, which is associated with an increased risk of heart attack, stroke, and death.

Finally, the International Consultation in Sexual Medicine (J Sex Med 2010;7:1608) concluded that:
• Low endogenous testosterone levels correlate with an increased risk for adverse cardiovascular events
• High endogenous testosterone levels appear to be beneficially associated with decrease mortality due to all causes, including cardiovascular disease and cancer
• Testosterone supplementation in men is relatively safe in terms of cardiovascular health
• Testosterone use in men with low testosterone leads to inconsequential changes in blood pressure, glycemic control and all lipid fractions.
Bottom Line: Low testosterone levels are associated with increased atherosclerosis. Most studies confirm that administration of testosterone to men has neutral effects on cardiovascular risk factors and cardiac events. For men with a history of heart disease, a careful discussion between the doctor and patient should take place.
*http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0085805?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+(PLOS+ONE+Alerts%3A+New+Articles)

Take Two (Aspirins) “At Night” And You Won’t Need To Call Me In the Morning

November 22, 2013

Take Two “At Night” And You Won’t Need To Call Me In the Morning

For several decades doctors have been prescribing low dose aspirin as means to protect against heart disease. Most men, including myself, take the aspirin in the morning. The researchers wanted to see if taking aspirin at night could better thin a person’s blood and potentially lower their heart attack risks.
Since the 1980s, it’s been known that cardiovascular events happen more often in the morning. Morning hours are a peak period of activity for platelets, blood cells that aid in clotting, he said. Doctors suspect that might have a hand in the increased risk of heart attacks and strokes in the morning.
Aspirin reduces the activity of platelets, and thus reduces the chance that those platelets will clot in the bloodstream and cause a heart attack or stroke, according to the findings.

Until now most doctors didn’t feel that timing of the dose, morning or evening, would matter. That’s because aspirin has a long-lasting effect on platelets, helping thin the blood for days after it is taken.
That’s why, prior to surgery, patients are told to hold off on aspirin for five to seven days, and why it continues to thin your blood even when you miss a dose.

But the Dutch researchers found that taking aspirin at bedtime reduced platelet activity more than taking it in the morning, apparently because it headed off the body’s normal morning surge in platelet activity.
The team also found that people who took aspirin at bedtime did not suffer any more stomach upset or other side effects than people who took it in the morning,.

Cardiologists who have reviewed this report suggest that until larger follow-up studies take place, people prescribed aspirin for heart problems should continue to take it whenever in the day they like.

Bottom Line: Taking baby aspirin has an affect on blood clotting mechanism and prevents heart attacks and strokes. Since there is no disadvantage to taking the medicine at night, I plan to use this medication before going to bed. If you have any questions about this recommendation, ask your doctor

Testosterone And Heart Disease – Facts and Caveats

November 6, 2013

Like most urologists, endocrinologists, and cardiologists, I have received numerous calls from men who have symptoms of low testosterone, documented decrease in their blood testosterone level, and who are receiving testosterone replacement therapy about a study that appeared in a reputable medical journal that treatment with testosterone increases the risk of heart disease. (JAMA. 2013;310(17):1829-1836. doi:10.1001/jama.2013.280386).

Let’s look at some facts. The human body is always trying to achieve homeostasis which is defined as “The ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes.” What does this mean? It means that the body is always trying to stay normal without deviations from normal. For example, if a man drinks too much water, the kidneys will increase the excretion of water. If a man is dehydrated, the kidneys will try and conserve water to prevent the problems associated with dehydration. If a man has diabetes, the doctor will recommend a treatment to lower the blood sugar. If a man has high blood pressure, the doctor will recommend dietary changes, exercise, and perhaps medication to lower the blood pressure. If a man has anemia or a low blood count because of iron deficiency, the doctor will prescribe iron supplements. If a man has a deficiency in vitamin D, then the doctor will recommend increase the consumption of this necessary vitamin. These actions are what doctors do every day; they attempt to achieve a normal equilibrium in the body as this is the best way to restore and maintain health.

This same reasoning applies to men who are deficient in testosterone. Testosterone is a necessary hormone produced in the testicles that is responsible for a man’s sex drive, muscle mass, energy level, bone strength, and even a man’s mood which may cause depression if the hormone is low and not returned to normal.

There are more than 13 million men in the United States who suffer from testosterone deficiency. For men who receive treatment, they usually report significant improvement in their symptoms. There are many conflicting reports about testosterone and heart disease. There are even studies that support that low testosterone increases the risk of heart disease and that treating the deficiency with hormone replacement therapy may be protective of heart disease.

I would like to list several comments about the study that was reported in the recent Journal of the American Medical Association (JAMA).

Of nearly 7,500 guys who did not get extra T, about 1 in 5 had bad cardiovascular outcomes, including stroke, heart attack or death. In the more than 1,200 men who got testosterone, nearly 1 in 4 had those terrible problems, an increased risk of nearly 30 percent. A truly scientific study has similar number of study patients in each group, not 7500 in the control group and 1200 in the experimental group.
The researchers concluded that taking testosterone came with an increased risk of an adverse outcome. If a statistician would add up the actual reported events in the paper for each group and divide by the numbers of men in each group. What you will find is that the absolute risk of events (death, heart attack, or a stroke) was 10% in men treated with T and 21% in men not treated. That’s right- the risk was REDUCED BY HALF in men treated with T. So a closer scrutiny needs to be done before conclusions can be made and distributed to the media.
This is obviously the opposite of what the authors reported. They come up with absolute risk rates that are not explained by any numbers in their paper. They used a complex statistical analysis to get to their conclusions without showing the numbers it was based on.

That’s not the whole story, though. Dr. Anne Cappola of the Perelman School of Medicine at the University of Pennsylvania wrote in an accompanying editorial: “The most important question is the generalizing the results of this study to the broader population of men taking testosterone ….” The take home message is not possible to generalize from this study to the entire population of men some of whom may have a low testosterone level.
That’s a very big caveat: By definition, all the men in the study were older than 60 and all had heart problems. It’s still not clear whether those same risks apply to younger, healthier guys.
“These were sick, older veterans,” Dr. Michael Ho, a cardiologist with the VA Eastern Colorado Health Care System who helped direct the study, said in an interview. Many were obese, had diabetes, and other ailments, he said. Obese men with diabetes and other co-morbid conditions are certainly at risk for heart disease, stroke, and even death.

Bottom Line: So what is a man who has low testosterone to do? I would suggest that they have a discussion with their doctor. If they have symptoms of low testosterone, and a documented level of low testosterone blood test, then the doctor and the patient have to weight the risks of testosterone replacement therapy versus the benefits. Certainly if the benefits outweigh the risks and the risks are composed of an older man with heart disease, diabetes, and other illnesses, then raising the testosterone level may not be in his best interest.