Who Do You Believe?

The FDA is a little worried about testosterone.

In fact, they want the label on vials of testosterone to carry a warning that suggests that it may increase the risk of heart attack.  This is despite their published belief that there’s only a “weak signal of cardiovascular risk” associated with the use of testosterone.

But you know who isn’t worried about testosterone at all? The Journal of the American Heart Association (AHA).

Let’s see, who do we put more faith in, a huge government run agency that’s long been accused of being overly cautious in the approval of new, potentially life-saving drugs, along with being protective of corporate profits over public health, or do we trust the publication of the AHA, a non-profit organization that works tirelessly to reduce disability and death caused by cardiovascular disease and stroke?

Maybe that’s an unfair and manipulative question, so why don’t we look at the facts so you can decide for yourself?

Lots of Loose Threads

The FDA got themselves in a tizzy over a single study that appeared in the journal Plos One  (study link) in early 2014.

The authors of the study examined a large healthcare database for guys who’d been on testosterone replacement therapy (TRT) for 90 days. Younger men with a history of heart disease who started TRT had a two to three-fold increase in the risk of myocardial infarction. Guys over 65 who started TRT had a two-fold increase in the risk of myocardial infarction, regardless of their cardiovascular history.

Sounds pretty damning, doesn’t it?  Yeah, until you start to pull at one, two, three, or ten loose threads. Then the whole thing falls apart like an old, moth-eaten lab coat.

The study didn’t even bother to look at pre- and post-therapy testosterone levels. Neither did they measure estrogen levels or red blood cell counts.

It’s a basic fact of testosterone science that some people have higher levels of an enzyme called aromatase that converts testosterone to estrogen. Every man needs some estrogen for sperm maturation and a healthy libido, but if the levels of estrogen get too high, it can potentially lead to heart attack and stroke.

That’s why any responsible TRT doctor will, if necessary, prescribe medications (anti-aromatases) to regulate estrogen levels that are out of whack.

Similarly, if testosterone is over-dosed and not monitored, it can potentially lead to the production of more red blood cells, which makes the blood thicker and harder to pump, which in itself can lead to heart attack or stroke.

But neither of these things were monitored or even considered by the authors of the Plos One study!

It could have very well been the case that if indeed these men had an increased incidence of myocardial infarction, it was because 1) their testosterone levels (and dosing) weren’t monitored, and 2) they might have had elevated estradiol levels or RBC counts that weren’t addressed by simple adjustments to their testosterone therapy.

Another problem with the Plos One study had to do with their control group, which consisted of men who were using PDE5 inhibitors, otherwise known as erectile dysfunction drugs. PDE5 drugs relax blood vessels, so much so that some of them have even been used to treat hypertension. That means the entire control group in the Plos One study was on meds that prevent heart attacks!

In what Bizarro world does a group of men on heart-attack preventative drugs make for a valid control group when you’re studying the alleged heart-attack causing effects of a second drug?

It’s like conducting a study to see if your new nasal congestion medication causes fingers and toes to fall off and setting up a control group consisting entirely of lepers.

Let’s synopsize the problems:

  1. The study didn’t consider levels of testosterone before treatment or after treatment. Therefore, we have no idea if the men had low testosterone in the first place, or if in fact they were being grossly overdosed.
  1. The study didn’t monitor estrogen levels or red blood cell levels. If high estrogen levels aren’t addressed by medication and high red blood cell counts aren’t adjusted by changes in dosing, heart problems are possible.
  1. The study’s entire control group was on a drug that prevents heart attacks, making the comparison between them and the testosterone group ludicrous.

Over 100 Studies Supporting Testosterone Replacement

But let’s go back in time a mere month or two before the Plos Study was published. A meta-study in the Journal of the American Heart Association (meta-study link) looked at over 100 testosterone studies and they saw that higher levels of testosterone were essential to heart health.

They reported that low testosterone is associated with abnormal EKG readings and that men with higher levels were 25% less likely to suffer from sudden cardiac arrest.

In fact, the journal reported that low testosterone was associated with a higher rate of mortality in general, along with higher rates of cardiovascular mortality, obesity, and diabetes!

The list of possible conditions associated with low testosterone was downright scary:

  • Higher risk of cardiovascular disease
  • Narrowing of carotid arteries
  • Abnormal EKG
  • More frequent congestive heart failure
  • Increased incidence of angina
  • Increased body mass index
  • Type II diabetes
  • Metabolic syndrome
  • Insulin resistance
  • More belly fat
  • Higher death rate from all causes, including cardiac mortality

Here are a couple of paragraphs taken directly from the study:

” Low endogenous bioavailable testosterone levels have been shown to be associated with higher rates of all causes of cardiovascular-related mortality. Patients suffering from coronary heart disease, congestive heart failure, type II diabetes, and obesity have all been shown to have lower levels of endogenous testosterone compared with those in health controls.

“In addition, the severity of coronary artery disease and congestive heart failure correlates with the degree of testosterone deficiency.

“…This review article has demonstrated that normal testosterone levels play an important role in maintaining cardiovascular health, and testosterone replacement therapy in men with hypogonadism improves obesity, type II diabetes, myocardial ischemia, exercise capacity, and QTc length [a measure related to heart beat rate].”

So what it comes down to is that you have one ill-conceived study portraying testosterone in a bad light, compared to at least 100 others proving that low levels of testosterone are bad, very bad for your health.

At the very least, the FDA should rescind their edict that bottles of testosterone carry a warning about heart attacks.

It Comes Down to Competence

What you should take from this article is that low levels of testosterone have potentially dire consequences for men, but if you do decide to undertake the great journey that is TRT, you must do so with the aid of a competent, concerned physician who’ll monitor your before and after testosterone levels, check your estrogen levels and red blood cell count, and take corrective steps if any are out of healthy ranges.