Testosterone Therapy May Actually Increase Your Risk of Stroke,
Heart Attack and Death
November 22, 2013
Story at-a-glance
After age 30, a man’s testosterone levels begin to decline
and continue to do so as he ages, leading to symptoms such
as decreased sex drive, erectile dysfunction, depressed
mood, and difficulties with concentration and memory
Conventional treatment for low testosterone revolves around
synthetic testosterone hormone replacement therapy, using
either a testosterone cream, gel or patch
Recent research has raised a red flag, warning men that
testosterone therapy may increase your risk of dying from a
sudden stroke or heart attack
The study found that testosterone use was associated with a
29 percent increased risk for an adverse event—regardless of
whether they had underlying coronary heart disease or not
Dietary and exercise changes, particularly limiting
sugar/fructose, eating healthy saturated fats and engaging
in high-intensity exercises, Power Plate, and strength
training, can be very effective at boosting testosterone
levels naturally
By Dr. Mercola
While primarily associated with the notion of “manhood”
and the attributes this word conjures up, the androgenic sex
hormone testosterone plays an important role in a man’s
health and wellbeing over and beyond those related to sexual
prowess.
For example, testosterone helps your body maintain muscle
mass, bone density, optimal lipid profiles and levels of red
blood cells, and can impart a general sense of vigor and
“youthfulness.”
Around the age of 30, testosterone levels begin to
decline. Symptoms of declining testosterone levels in men
include decreased sex drive, erectile dysfunction,
depression, poor concentration and impaired memory. Men with
low testosterone levels may also experience weight gain,
breast enlargement, and problems urinating.
Conventional treatment for low testosterone revolves
around synthetic testosterone hormone replacement therapy,
using either a testosterone cream, gel or patch.
However, recent research1
has raised a red flag, warning men that testosterone therapy
may increase your risk of dying from a sudden stroke or
heart attack. The study in question does have limitations
however, and more research is likely needed before any
definitive conclusions can be drawn.
That said, I believe it’s worth noting that there’s
almost always going to be a significant difference between
taking a synthetic hormone versus encouraging your body to
produce more of a hormone naturally. I personally
do not believe the risks are in any way comparable between
these two strategies—both of which I’ll address below.
Are Men Putting Themselves at Risk by Misusing Testosterone?
I know first-hand that low testosterone is not an
automatic outcome of aging, provided you incorporate certain
lifestyle strategies that can naturally boost your
testosterone levels.
Moreover, I firmly believe that naturally boosting your
body’s production of testosterone (and other hormones)
through lifestyle strategies such as exercise and diet will
not be as likely to have negative impacts on your heart or
longevity. On the contrary, these strategies are part and
parcel of an overall healthy lifestyle, so they also
automatically reduce your risk of most chronic
disease, including heart- and cardiovascular disease.
Unfortunately, many men who feel they’ve “lost the spring
in their step” opt for the quick and easy route of hormone
replacement therapy. Data from the US Food and Drug
Administration (FDA) shows annual prescription rates for
testosterone have increased more than five-fold
between 2000 and 20112,
3. An estimated 5.3 million testosterone
prescriptions were written in 2011.
This dramatic increase is causing researchers to question
whether men may be abusing the hormone,4,
5,
6 as professional guidelines only recommend
testosterone replacement therapy for men who have
symptomatic testosterone deficiency.
According to the Endocrine Society, which is responsible
for setting the clinical guidelines for testosterone
replacement therapy, testosterone should only be given to
men with persistent symptoms and “unequivocally low
testosterone levels,” a condition known as hypogonadism. To
determine this, you have to actually test your testosterone
level, which is done with a blood test—ideally more than
once, as your testosterone level can rise and fall during
each day. Recent findings7
indicate that 25 percent of men given a prescription for
testosterone did not have their levels tested prior to
receiving a prescription, and of the remaining 75 percent,
it was unclear as to how many actually had a testosterone
deficiency.
Testosterone Therapy May Increase Mortality, Study Says
The featured study,8
published in JAMA, noted that “a recent randomized clinical
trial of testosterone therapy in men with a high prevalence
of cardiovascular diseases was stopped prematurely due to
adverse cardiovascular events.” To further assess this
potential link between testosterone therapy and heart
attack, stroke and all-cause mortality, the researchers
looked at more than 8700 men who underwent a coronary
angiography9
(a test that checks for blocked arteries). They wanted to
determine whether having underlying coronary artery disease
might modify the outcome in men taking testosterone.
Perhaps it’s just more risky to take testosterone if you
already have heart disease? That did not turn out to be the
case, overall... All of the participants had a total
testosterone level of less than 300 ng/dL. Of the 1,223
patients who started testosterone therapy after their
coronary angiography, nearly 26 percent of them suffered an
adverse event (stroke, heart attack and/or death) within
three years. In the group that did not take testosterone,
less than 20 percent had an adverse event.
After adjusting for other differences between the groups,
testosterone use was associated with a 29 percent increased
risk for an adverse event—regardless of whether they had
underlying coronary heart disease or not. The authors
concluded that:
“Among a cohort of men in the VA health care
system who underwent coronary angiography and had a low
serum testosterone level, the use of testosterone
therapy was associated with increased risk of adverse
outcomes. These findings may inform the discussion about
the potential risks of testosterone therapy.”
Other research10
published earlier this year found that testosterone
replacement therapy did not appear to have any positive
effects on the cardiovascular health of men who took it,
noting that the “cardiovascular risk-benefit profile of
testosterone therapy remains largely evasive.”
Interestingly, the analysis does suggest that low
testosterone and heart disease might both be caused by “poor
overall health,” as stated by lead researcher, Dr. Johannes
Ruige.11
This, again, is why I recommend focusing your efforts on
healthy lifestyle strategies such as exercise rather than
taking synthetic hormone replacement, the risk/benefit ratio
of which is still largely unknown...
Estrogen May Be Equally Important as Testosterone in Men
Another thing to think about is this: Recent research12
has found that there are significant individual variations
in the amount of testosterone required for any particular
man to maintain lean body mass, strength, and sexual
function. Knowing this, it makes logical sense to allow your
body to normalize and make what it needs for optimal health,
rather than supplying it with an arbitrary dose of hormone
thought to be ideal for men in general.
Furthermore, researchers have now discovered that
estrogen also plays an important role in many of the
processes previously thought to be relegated to testosterone
alone.13,
14 For example, they’ve determined that, in men,
testosterone deficiency accounts for decreases in lean mass,
muscle size and strength, while estrogen deficiency was the
primary culprit when it came to increases in body fat. Both
testosterone and estrogen were found to be
important for sexual function, and a deficiency in either
had a negative impact on the men’s libido. According to the
lead author, Dr. Joel Finkelstein, an endocrinologist at
Harvard Medical School:
“Some of the symptoms routinely attributed to
testosterone deficiency are actually partially or almost
exclusively caused by the decline in estrogens.”
Despite individual variations, Dr. Finkelstein’s research
offers valuable insight into the function and behavior of
estrogen and testosterone at different levels in a man’s
body. For example, they found that less testosterone is
actually needed for muscle maintenance than previously
thought. They also found that:
In young men, the average testosterone level is
about 550 nanograms per deciliter (ng/dl)
Muscle size and strength does not become adversely
affected until testosterone levels drop below 200 ng/dl,
which has previously been considered extremely
low
Fat accumulation, however, increases at testosterone
levels of 300-350 ng/dl, due to its impact on estrogen
Libido increases steadily with simultaneous
increases in testosterone and estrogen
Please note that men are NOT advised to take estrogen
replacement therapy, as this could cause feminization, such
as enlarged breasts. As your testosterone levels rise, your
body will automatically produce more estrogen, so the key is
to maintain your testosterone level—ideally by incorporating
the strategies I discuss below.
You Can Raise Your Testosterone- and HGH Levels Naturally
Personally, I do not recommend using testosterone hormone
replacement. If you indeed have low testosterone, you can
consider
trans rectal DHEA cream. DHEA is the most abundant
androgen precursor prohormone in the human body, meaning
it’s the largest raw material your body uses to produce
other vital hormones, including testosterone in men and
estrogen in women. However, I believe most men don’t even
need that, were you to take full advantage of your body’s
natural ability to optimize hormones like testosterone and
human growth hormone (HGH). Testosterone production follows
a similar decline with age as HGH illustrated below.
Just like testosterone, your HGH levels also sharply
decline after the age of 30. Both of these hormones are
boosted in response to short, intense exercise. I
personally do not take any hormone or prohormone
supplements; rather I’ve been doing
Peak exercises for just over three years, and at the age
of 59, my testosterone- and HGH levels (listed below) are
still well within the normal range for a young adult male
without the aid of ANY prescriptions, hormones and hormone
precursor supplements, clearly demonstrating it is possible
to normalize these hormones using these natural strategies:
My total testosterone: 982 ng/dl (normal test range:
250-1,100 ng/dl)
My free testosterone: 117 pg/ml (normal test range:
35-155 pg/ml)
My HGH: 14,000 pg, more than three times the normal
test range of 1,000-4,000 pg/24 hours
To Raise Your Hormone Levels, Exercise Intensely, but
Briefly
Below is a summary and video demonstration of what a
typical high-intensity Peak Fitness routine might look like.
This type of exercise—short intervals of high intensity
exertion followed by periods of rest—emulate the daily
physical actions and movements of ancient man. This,
researchers say, is what your body is hard-wired for. Keep
in mind that high intensity interval training is the only
type of exercise that will help boost your testosterone- and
HGH levels.
A slow one-hour jog will not have this effect, so
it’s critical to make sure you’re exercising correctly
if you want to affect your hormone levels. The entire
workout is only 20 minutes, and 75 percent of that time is
warming up, recovering or cooling down. You're really only
working out intensely for four minutes. It's hard to believe
if you have never done this, that you can actually get that
much benefit from only four minutes of intense exercise, but
that's all you need!
Warm up for three minutes
Exercise as hard and fast as you can for 30 seconds.
You should feel like you couldn't possibly go on another
few seconds
Recover at a slow to moderate pace for 90 seconds
Repeat the high intensity exercise and recovery 7
more times
More Ways to Boost Testosterone and HGH
Besides high intensity exercise, there are several other
strategies that will also boost your testosterone levels
naturally. These are appropriate for virtually anyone, male
or female, as they carry only beneficial "side effects."
I’ve listed four of my favorite strategies below. For even
more tips, check out the slide show. More details can also
be found in my previous article,
9 Body Hacks to Naturally Increase Testosterone.
Weight training. When you use
strength training to raise your testosterone, you’ll
want to increase the weight and lower your number of
reps. Focus on doing exercises that work a wider number
of muscles, such as squats or dead lifts. You can take
your workout to the next level by learning the
principles of
Super-Slow Weight Training. For more information on
how exercise can be used as a natural testosterone
booster, read my article “Testosterone
Surge After Exercise May Help Remodel the Mind.”
Whole body vibration training (WBVT)
using a
Power Plate. In addition to the Peak Fitness
exercises I do 10 minutes of Power Plate training twice
a day and this likely also improved my hormones. WBVT in
some ways simulate high intensity exercise by
stimulating your white (fast-twitch) muscle fiber. This
kick-starts your pituitary gland into making more growth
hormone, which helps you build lean body mass and burn
fat.
Address your diet. This is critical
for a number of reasons. First of all, if you're
overweight, shedding the excess pounds may increase your
testosterone levels, according to recent research.15
Testosterone levels also decrease after you eat sugar.
This is likely because sugar and fructose raises your
insulin level, which is another factor leading to low
testosterone. Ideally, keep your total fructose
consumption below 25 grams per day. If you have insulin
resistance and are overweight, have high blood pressure,
diabetes or high cholesterol, you’d be well advised to
keep it under 15 grams per day.
The most efficient way to shed excess weight and
normalize your insulin levels at the same time is to
strictly limit the amount of sugar/fructose and grains
in your diet, and replacing them with vegetables and
healthy fats, such as organic pastured egg yolks,
avocado, coconut oil, butter made from raw grass-fed
organic milk, and raw nuts.
Saturated fats are in fact essential for
building testosterone. Research shows that a diet with
less than 40 percent of energy as fat (and that mainly
from animal sources, i.e. saturated) lead to a decrease
in testosterone levels.16
My personal diet is about 70-80 percent healthy fat, and
other experts agree that the ideal diet includes
somewhere between 50-70 percent fat. I've detailed a
step-by-step guide to this type of healthy eating
program in my optimized
nutrition plan.
Intermittent fasting. Another
effective strategy for enhancing both testosterone and
HGH release is
intermittent fasting. It helps boost testosterone by
improving the expression of satiety hormones, like
insulin, leptin, adiponectin, glucacgon-like peptide-1
(GLP-1), cholecystokinin (CKK), and melanocortins, which
are linked to healthy testosterone function, increased
libido, and the prevention of age-induced testosterone
decline.
Do You Really Need Testosterone Therapy?
For most men, the answer to declining testosterone levels
comes not from a prescription hormone replacement, but in
the form of a healthy, active lifestyle. If you’re
still deficient in testosterone after implementing high
intensity exercise and strength training, along with the
recommended modifications to your diet and, ideally,
intermittent fasting, then you could try trans-mucosal DHEA.
DHEA is a precursor hormone that is crucial for the
creation of vital hormones, including testosterone and other
sex hormones.
For information on DHEA supplementation, please see my
previous article
Testosterone Decline: How to Address This Challenge to
'Manhood'. In it, you can also learn more about other
helpful dietary supplements, and how endocrine-disrupting
chemicals in your home and environment may adversely affect
your hormonal balance. Personally, I’ve been able to
maintain both testosterone and HGH levels comparable to that
of men half my age, simply by implementing high intensity
exercise and intermittent fasting, along with my standard
dietary recommendations, which apply to everyone, regardless
of age or sex.
Clearly, low testosterone is not an inevitable fate for
aging men, and you don’t have to risk your health by
experimenting with synthetic hormones in order to maintain
youthful levels. Even if you believe the risks to your heart
are small (although I personally would not consider a nearly
30 percent increased risk to be negligible), I encourage you
to consider the big picture.
Using exercise and diet will allow your body to optimize
testosterone, HGH and other hormones to levels that are
ideal for you, and will have countless synergistic
beneficial effects on your health. By opting for hormone
therapy as your first line of treatment, you’re cheating
yourself out of most, if not all, of those benefits—and you
may even end up doing more harm than good.