A critical analysis of testosterone supplementation therapy and cardiovascular risk in elderly men

The Effect of Low Testosterone and Estrogen Levels on Progressive Coronary Artery Disease in Men

BACKGROUND

Age-related morbidity and mortality rates from coronary heart disease (CHD) are higher in men than in women. Abnormal androgen levels cause a variety of abnormal symptoms in men. Testosterone and estrogen are the main sex hormone in men and women, respectively, and studies have shown that they have important roles in cardiovascular health and disease.

METHODS

We measured testosterone and estrogen in 102 men with coronary heart disease and 45 controls. Blood samples were collected from subjects and plasma testosterone and estrogen were measured by ELISA.

RESULTS

Men with coronary heart disease had less testosterone (OD Ratio: 0.782) and estrogen (OD Ratio: 0.955) than controls.

CONCLUSION

Low testosterone and estrogen levels correlate with coronary artery disease.

Testosterone therapy improves well being and psychological health

PURPOSE OF REVIEW

To ascertain whether testosterone therapy (TTh) improves psychological health and a sense of overall well being in a number of clinical domains.

RECENT FINDINGS

Recent work suggests small but durable and replicable improvements in the components of male health and well being.

SUMMARY

Symptomatic hypogonadism is frequently associated with decreased libido and fatigue that contributes to lowered overall quality-of-life and worsening psychological health. This manuscript will review the evidence behind the generalized benefits of TTh on overall male health as well as on depression and cognitive function in particular. Influence of TTh on body composition and its relationship to cardiovascular disease are also discussed in this overall context.

Low Plasma Testosterone Is Associated With Elevated Cardiovascular Disease Biomarkers

BACKGROUND

The relation between testosterone (T) plasma concentration and cardiovascular (CV) risk is unclear, with evidence supporting increased risk in men with low and high T levels. Few studies have assessed CV risk as a function of plasma T levels using objective biomarkers.

AIM

To determine the relation between T levels and high-sensitivity CV risk biomarkers.

METHODS

Ten thousand forty-one male patients were identified in the database of a commercial clinical laboratory performing biomarker testing. Patients were grouped by total T concentration and associations with the following biomarkers were determined: cardiac troponin I (cTnI), endothelin-1 (ET-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-17A, N-terminal pro-B-type natriuretic peptide (NTproBNP), high-density lipoprotein (HDL) cholesterol, high-sensitivity C-reactive protein (hs-CRP), hemoglobin A_1c (HbA_1c), and leptin.

OUTCOMES

Association of CV risk markers with levels of T in men.

RESULTS

The median age of the cohort was 58 years (interquartile range = 48-68), and the median plasma T level was 420 ng/dL (interquartile range = 304-565); T levels did not vary with patient age. An inverse relation between plasma T levels and CV risk was observed for 9 of 10 CV markers: cTnI, ET-1, IL-6, TNF-α, NTproBNP, HDL cholesterol, hs-CRP, HbA_1c, and leptin. Even after adjusting for age, body mass index, HbA_1c, hs-CRP, and HDL cholesterol levels, the CV markers IL-6, ET-1, NTproBNP, and leptin were significantly associated with a T level lower than 250 ng/dL.

CLINICAL IMPLICATIONS

Men with low T levels could be at increased risk for increased CV disease as seen by increased CV risk markers.

STRENGTH AND LIMITATIONS

This study was performed in a group of 10,041 men and is the first study to examine CV risk associated with circulating T levels using a large panel of 10 objective biomarkers. This study is limited by an absence of clinical data indicating whether men had pre-existing CV disease or other CV risk factors.

CONCLUSION

Men with low plasma T levels exhibit increases in CV risk markers, consistent with a potential increased risk of CV disease. Pastuszak AW, Kohn TP, Estis J, Lipshultz LI. Low Plasma Testosterone Is Associated With Elevated Cardiovascular Disease Biomarkers. J Sex Med 2017;14:1095-1103.

Dietary Adjuncts for Improving Testosterone Levels in Hypogonadal Males

An increasing number of men are being diagnosed with hypogonadism. While many benefit from testosterone supplementation therapy, others who do not meet the criteria for hormone supplementation have turned to dietary adjuncts as a way or gaining improvements in libido, energy, and physical performance. These oral adjunct medications include controlled substances such as androstenedione, androstenediol as well as other “over-the-counter” options like DHEA (dehydroepiandrosterone) and herbal remedies like Tribulus terrestris. This review will focus on the use of these adjunct medications in isolation, or in combination with testosterone supplementation therapy as well as the biochemical nature of the supplements, the results of scientific trials as well as the side effects that limit their use. At the end of this review, physicians will have an improved understanding of the popular testosterone adjuncts being used currently as well as the availability of these substances and how they are used.