Testosterone Replacement-Relationship With Heart Disease

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.

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

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?

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.

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

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.

Good News For the Bedroom-Sex Is Heart Healthy

Certainly there are some men who worry that having sexual intercourse may cause a heart attack. Or men who have had a heart attack are at risk for another attack if they have sexual intercourse. Well, there’s good news for men. A recent study from England shows men who indulge in regular lovemaking are up to 45 per cent less likely to develop life-threatening heart conditions than men who have sex once a month or less.

The study, of over 1,000 men, shows sex appears to have a protective effect on the male heart but did not examine whether women benefit too.

Now the American researchers who carried out the investigation are calling for doctors to screen men for sexual activity when assessing their risk of heart disease.

Every year, around 270,000 people in Britain suffer a heart attack, and coronary disease remains Britain’s biggest killer.

Although sex has long been regarded as good for physical and mental health, there has been little scientific evidence to show the full benefits that frequent intercourse can have on major illnesses such as heart disease.

In the latest study, scientists at the New England Research Institute in Massachusetts, tracked the sexual activity of men aged between 40 and 70 who were taking part in a long-term project called the Massachusetts Male Ageing Study, which began back in 1987.
At regular points over a 16-year period, each man was questioned on how often they had sex and then checked for signs of heart disease.
Researchers took into account other risk factors, such as their age, weight, blood pressure and cholesterol levels.

The results, published in the American Journal of Cardiology, showed men who made love at least twice a week were much less likely to have heart disease than those whose sexual encounters were limited to once a month or less.

In a report on their findings, researchers said the benefits of sex could be due to both the physical and emotional effects on the body.
Men with the desire for frequent sexual activity and who are able to engage in it are likely to be healthier.

But sex in some forms has a physical activity component that might directly serve to protect cardiovascular health.

Also, men who have frequent sex might be more likely to be in a supportive intimate relationship and this might improve health through stress reduction and social support.

And there’s a benefit for the women in your life as well: Regular sex can even boost a woman’s sense of smell by triggering the release of a hormone called prolactin, according to scientists at Calgary University in Canada. This may be a mechanism to help mums bond with their new babies.

Bottom Line: No one disagrees that sex is good and sex might just be good for your health as well. So men, if you are looking for a reason to have regular sex, tell your partner to do it for your health and her health as well. It’s a twofer!

http://www.telegraph.co.uk/health/healthnews/6950548/Having-sex-twice-a-week-reduces-chance-of-heart-attack-by-half.html

Testosterone and Heart Disease – Facts & Caveats

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)

Sex After a Heart Attack

A man has a recent heart attack. He is eager to get back in the saddle and remembers the movie, Something’s Gotta Give, when Jack Nicholson, who had a recent heart attack, asks his doctor about when “his best friend” can start getting back into action. He’s told that he has to wait until he can climb two flights of stairs without shortness of breadth or chest pain. Both the man and his partner are concerned if sex trigger could another heart attack.
It is well documented that fewer than 1% of heart attacks come from having sex. It makes sense to think of sex as a form of exercise: If your doctor clears you for physical activity, you’re also likely safe for sex. Remember the two flights of stairs test.
Most men and their partners are uncomfortable broaching the topic with their doctor. Most doctors are comfortable talking about sexual intimacy and you shouldn’t avoid the topic. Often the patient is surprised — or even relieved — that the doctor raises the subject.
Similar to any type of exercise, if you begin to feel symptoms such as chest pain, abnormal shortness of breath, fatigue, dizziness, or palpitations, it definitely makes sense to slow down what you’re doing, whether you’re a man or a woman. If you’re pretty certain it’s angina, which is temporary pain or pressure in the chest when the heart doesn’t get enough oxygen, it might help to take your nitroglycerin.
The exception to that advice is for men who use medication for erectile dysfunction such as Viagra, Levitra, and Cialis — it’s dangerous to take nitroglycerin. Your blood pressure can fall to dangerously low levels, and there’s an increased risk of heart attack and even death. If you’re on an erectile dysfunction drug and have heart-related symptoms during sex, call your doctor.
Bottom Line: Sexual intimacy is important to men at all ages and includes men who have had a recent heart attack. A candid conversation will help you get back to enjoying a sexual relationship with your significant other. Talk to your doctor

Sex After a Heart Attack: What You Need To Know

Your Average Middle Age Couple Who Are In Love And Wish To Be Sexually Active

Every man or woman who has had a heart attack has concerns when they can begin having sexual intimacy after recovering from a heart attack. Certainly the movie, Something’s Gotta Give with Jack Nicholson and Diane Keaton, offers the protagonist advice about engaging in sexual intimacy after a heart attack until the man can climb two flights of stairs without shortness of breadth or chest pain. Every woman is concerned whether resuming sexual activity may trigger another heart attack in her partner. We know depression is extremely common after a heart attack, especially for women. This blog will attempt to answer some of those questions that men and women have after a heart attack.

First, most cardiologist believe it is helpful for men to be in a supervised exercise program. These cardiac rehab programs teach men and women that it’s OK for them to exercise after a heart attack.

However, if you begin to feel symptoms such as chest pain, abnormal shortness of breath, fatigue, dizziness, or palpitations, it definitely makes sense to slow down what you’re doing, whether you’re a man or a woman. If you’re pretty certain it’s angina, which is temporary pain or pressure in the chest when the heart doesn’t get enough oxygen, it might help to take your nitroglycerin tablet under your tongue.

Now the warning: Just like the movie, Something’s Gotta Give, men who use medication for erectile dysfunction, such as Viagra, Levitra, or Cialis, — they should not take nitroglycerin. Your blood pressure can fall to dangerously low levels, and there’s an increased risk of heart attack and even death. If you’re on an erectile dysfunction drug and have heart-related symptoms during sex, call your doctor.

Yes, and sexual intimacy is often related to the emotions that follow a diagnosis of heart disease. It influences people’s lives in many different ways, and sexual activity is one of them. A new diagnosis of heart disease — or even a surgical scar — can make people feel less attractive. Some drugs have side effects that diminish sexual interest and performance. When patients feel angry and frustrated, it affects not only their sex lives but also their “couple” relationships.

Sexual intimacy is like a stress test. Engaging in sex shows that you’re capable of doing physical activity in which your heart rate and blood pressure go up. In a sense, you’re doing a stress test on your heart. If you tolerate that well and you feel good doing it, it suggests good things about your overall level of fitness and therefore your risk of heart disease.
Sex can also be a sign of healthy relationships and social supports. It shows you have the opportunities, frankly, and that you’re interested and engaged. Sex is a barometer for overall health.

Bottom Line: Sex is a good thing and sex is okay after a heart attack if your doctor gives you permission to exercise and engage in sexual intimacy. This is a discussion every man and woman needs to have with their doctor after having a heart attack and before leaving the hospital.

Erectile Dysfunction (Impotence)-a Dangling Stress Test

Erectile dysfunction (ED) or impotence may more than affect your relationship with your significant other. ED just may be a warning sign of impending heart disease.

Men with even mild erectile dysfunction — but no known heart problems — face a major extra risk of developing heart disease in the future. And as erectile dysfunction becomes more pronounced, signs of hidden heart disease and earlier death risk grow.

Not surprisingly, men already known to have a heart condition along with severe erectile dysfunction fare worst of all. Among men aged 45 and up without diagnosed heart disease, those with moderate or severe erectile dysfunction were up to 50 percent more likely to be hospitalized for heart problems. Erectile dysfunction boosted the risk for hospitalization with a diagnosis of heart disease.

Men with erectile dysfunction should take action by seeing a health professional and asking for a heart check.

An estimated 60 percent of men aged 70 and up suffer from moderate to severe erectile dysfunction. The condition can place major limits on sexual activity and require the use of drugs like Viagra, Levitra, or Cialis that can come with side effects.

A variety of causes can contribute to impotence, but it is widely acknowledged that erectile dysfunction is predominantly the result of underlying cardiovascular disease.

Doctors already believe that erectile dysfunction is an early warning sign of heart problems. The arteries of the penis are smaller than those of other parts of the body including the arteries to the heart and may be more likely to reveal problems when their lining deteriorates before heart symptoms occur.

Bottom Line: Men with severe erectile dysfunction, compared to those with no problem, were eight times more likely to have heart failure, 60 percent more likely to have heart disease and almost twice as likely to die of any cause.
 So before you ignore erectile dysfunction as occurring with age, think of your ED as a dangling stress test and see your doctor and get your heart checked out.

Secrets For the Salt Sensitive

I am a baby boomer and have joined the middle age club. I have a history of heart disease in my family and both parents were hypertensive. As a result I’m very salt sensitive. Salt added to your diet tends to hold onto water and increase your blood volume thus making your heart work harder to pump blood throughout the body. For those of you who have high blood pressure, heart disease, kidney disease, or are just salt sensitive, here are a few suggestions for limiting the salt intake in your diet.

You can easily tick off a list of salty, sodium-rich foods: potato chips, popcorn, hot dogs, pizza, pickles, and more. But there are plenty of high-sodium foods you probably aren’t aware of. According to the Centers for Disease Control, Americans get almost one-third of their sodium from breads and rolls, chicken and chicken dishes, pizza, egg dishes, and pasta dishes. That’s partly because these foods contain added salt and partly because we eat them so often. Here’s another staggering number: up to 80% of the salt in your food was put there by someone other than you.

Why does salt matter? Your body needs a little bit of the sodium in salt to contract muscles, send nerve impulses, and maintain a healthy balance of fluids. But too much sodium can increase blood pressure, make the heart work harder, thicken and stiffen blood vessels, and more. Higher salt and sodium consumption have been linked to increased risk of heart disease and stroke.
How can you avoid these hidden salt mines? Read food labels carefully. Look at both the amount of sodium per serving and the recommended daily sodium allowance percentage. Shop for products labeled “salt free,” or “no salt added,” or “low-sodium.” Avoid condiments such as soy sauce, ketchup, teriyaki sauce, and salad dressings, which tend to be loaded with salt.

Another good strategy is to limit your use of prepared and processed foods, which tend to be made with a lot of salt. Adding more fresh or frozen fruits and vegetables to your diet can also lower sodium and increase potassium.
Restaurant foods are often loaded with salt. Many restaurants now offer low-sodium choices. If your food is being made to order, don’t hesitate to ask that it be made without salt.

Use Ms. Dash or potassium containing salt substitutes. (Potassium salt substitutes should be avoided in patients with chronic renal failure) Try filling your salt shaker with a low- or no-sodium salt, or replace it with a shaker full of herbs and spices or a squeeze of lemon.

Bottom Line: Although salt may make food taste better, it can be hazardous to your health. If you are salt sensitive, consider alternatives that don’t affect the flavor of your foods but do protect your heart and lower your blood pressure.