Should Men Get HRT for Heart Health?
Risks of Testosterone Supplements Have To Be Weighed
Jan. 15, 2003 -- It's a controversial topic -- should men get testosterone replacement therapy when they hit midlife? A review of research finds that twice as many men with heart disease have low testosterone levels compared with men without heart disease. In fact, low testosterone is linked to a number of risk factors for heart disease.
Around the world, men are three times more likely to have heart disease than women, writes Kevin Channer, PhD, a researcher at Great Britain's Royal Hallamshire Hospital, located in Sheffield. His editorial appears in the current issue of the journal, Heart.
However, the influence of sex hormones on heart disease in men "has been relatively ignored," Channer says
Studying testosterone has been difficult, he writes. Only a small amount is flowing in the bloodstream, and that amount varies by age, body type, and weight -- partly because testosterone can get broken down into estrogen, and partly because the hormone levels decline with age.
Recent studies have shown that men with heart disease have significantly lower concentrations of testosterone in their blood. Also, a condition called hypogonadism -- a glandular disorder that causes low testosterone levels production -- is twice as common in men with heart disease than in the general population, Channer adds.
Men with overly high testosterone levels also have high LDL (the "bad" cholesterol), low HDL (the "good" cholesterol), high triglycerides (also "bad"); they also are more likely to be diabetic and have high blood pressure, he writes.
Studies have shown that increasing doses of testosterone in arteries causes them to dilate, increasing blood flow, and in veins, it improves exercise tolerance and reduces angina in men with heart disease. There is currently no evidence that testosterone replacement in men with hypogonadism increases their rate of prostate cancer -- however, those studies have been small, Channer concedes.
The subject of testosterone replacement therapy has caused much controversy over the past two or three decades, says Joseph Zmuda, PhD, an epidemiologist at the Graduate School of Public Health at University of Pittsburgh. Zmuda commented on the editorial for WebMD.