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 A new study links testosterone therapy to an increased risk of heart problems.
November 5th, 2013
04:27 PM ET
Testosterone treatment could be dangerous to the heartIt’s become the hot new treatment for older men. “T,” or testosterone replacement therapy, has been touted as the new way to turn back a man’s body clock and improve his sexual performance. But there may be trouble in paradise, according to new research. In a study published this week in the Journal of the American Medical Association, scientists have found that men taking testosterone therapy had a 29% greater risk of death, heart attack and stroke than those who were not on the hormone replacement. The study included 8,709 men with low testosterone levels, who underwent coronary angiography, a procedure used to open narrow or blocked coronary arteries, in the Veterans Affairs (VA) system between 2005 and 2011. Some were found not to have blockages. Researchers found the number of patients experiencing heart problems such as attacks and strokes three years after their angiographies, was 19.9% for those who were not on testosterone and 25.7% for those who were. Even when scientists accounted for other factors in the patients’ health, the increase of heart events in those on testosterone therapy was significant, according to the study.
"These findings raise concerns about the potential safety of testosterone therapy," said Dr. Rebecca Vigen, lead author and an internist at the University of Texas Southwestern Medical Center in Dallas. "Future studies including randomized controlled trials are needed to properly characterize the potential risks of testosterone therapy in men with comorbidities (other conditions)." But some doctors who looked at the study questioned the methods, saying many of these men already had heart issues. “You need to be careful about the conclusion you draw from this study,” says Dr. Warren Levy, a cardiologist and director of Virginia Heart, based in Northern Virginia. “The study is of men who had undergone cardiac catheterization - so that already selects out a higher-risk population. The conclusion may be that for men with a higher risk of cardiovascular disease, testosterone therapy may increase risk slightly.” So the question is, how does this affect men who are healthy? The male hormone replacement is so popular, prescriptions for the remedy reached 5.3 million a year in 2011 and are climbing, according to the study. Baby boomers find youth in testosterone "Perhaps the most important question is the generalizability of the results of this study to the broader population of men taking testosterone: men of this age group who are taking testosterone for 'low T syndrome' or for anti-aging purpose,s and younger men taking it for physical enhancement," Dr. Anne R. Cappola, an associate professor of medicine in the Division of Endocrinology, Diabetes, and Metabolism with the Perelman School of Medicine at the University of Pennsylvania and a contributing editor for the Journal of the American Medical Association, writes in an accompanying editorial. "In light of the high volume of prescriptions and aggressive marketing by testosterone manufacturers, prescribers and patients should be wary,“ says Cappola. “ We are just beginning to see the effects of hormone replacement therapy in men. In women, we have data from decades of research. But for men, we are still sort of in the dark.” Even when the men had a clean bill of health after no blockage was found when coronary angiographies were performed, they still had a high rate of heart problems if they were on testosterone therapy, Cappola points out. As to why testosterone effects the heart, scientists still don't understand the connection, but it has been shown the hormone can lower a patient's HDL, or good cholesterol. Yet doctors think it's more than that. So what’s the takeaway message for those who are toying with the idea of testosterone therapy? Study authors recommend men talk to their doctors about the hormone replacement and how it fits into their general health profile and should be cautious of it if they have a history of heart problems.
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love. Recent Comments
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Basically the risk is 5 percent higher, statistically meaningless. Thanks to testicular cancer, I have no choice but to take the stuff, so that makes me more comfortable.
This wouldn't be a problem anyway because you are just replacing what your body can't produce anymore.
I will say that it would not surprise me that taking too much as a replacement therapy when older COULD harm the heart though. Testosterone levels naturally drop with age, so trying to stop that may mess with the body.
Well let it kill my heart. If I can't stay awake or have sex I might as well die!
25 is a 25% increase over 20. Not a 5% increase. You can't just subtract percentages like that.
It is not in the interest of the government to play up the benefits of longevity with the use of these drugs because it would overtax the social security benefits far beyond the projected death rate for millions of baby boomers. It, like most everything like this, is money, money, money and has nothing to do with the quality of millions of lives. without T therapy 10s of thousands are brought to utter despair and depression bring on other health problems which all too often leads to far to many suicides.
this is a vanity treatment- it has no other reason or justification. it is the equivalent of barbie mentality for men. if it causes problems, the fda should either ban it altogether or strictly regulate and limit its use.
This is NOT always vanity treatment. I am 30, had testicular cancer, and no longer make my own testosterone. It is medically necessary because not having any is linked to killer heart conditions....STATISTICALLY MUCH MORE significant than this flimsy link.
Testosterone is limited by the FDA to patients with a prescription - and going a step further, is designated a CIII substance by the DEA (requires all the same monitoring as vicodin, for a reference), in spite of being the only CIII to have no evidence of causing addiction. They were a step ahead of you (and imho, took it quite far enough– without being overly regulatory).
Testosterone has legitimate uses.
Your statement is very broad and not accurate. I began testorsterone therapy after I became very depressed, irritable, and gained a lot of weight. My T readings were 285, which is the very low end of normal. Since taking the hormone, my mood has greatly lifted and I beginning to lose weight, not to mention I have more energy than before.
Hey, we all will die some day so I'd rather die of a heart attack while living a fulfilling existence rather than dying as a depressed old man.
Agree that this is not a vanity treatment. I have Wegener's Granularmytosys and the treatment stopped my testosterone production. My best level is 8. Only way to deal with that is testosterone treatment.
Bob, I'm sorry you had to go through testicular cancer. Just so you know, most people going through that would not want to supplement with androgen because it would help any metastases present to grow. That is also true with prostate cancer and is true with estrogens and progestins for breast cancer. Your adrenal glands produce a small amount of testosterone just like everyone's do (including women). You do not need that extra androgen to live any more than women do. Also, lower testosterone certainly does not "turn you into a woman". You are certainly free to choose to supplent to enable you to achieve erection but you don't have to do it. Women go through menopause and men go through andropause. It's natural though not at age 30. I spay and neuter all my pets and they are all happy and healthy.
How bout for someone who has a tumor wrapped around their pituitary gland, and the body does not produce testosterone....vanity huh?
nice try reasonablebe, you are clueless.
It's a far cry from a "vanity treatment". If you mean by vanity, that it allows my body to flow a bit smoother, so that on a good day..I can pull up my drawers, pants and get my socks part of the way on...yes..that's my silly vanity in play. It also really assists my vanity by making my hair greasy like a tween and the zits to go along with that. Ooooo, you mean the muscle growth? Yeah, if you have low testosterone, you don't get muscle growth. If your leveled out, than you are at the standard growth that everyone else has. In my case, it's a bit below that, until they get it all worked out. As for the growth elsewhere...I don't know who started that rumor, but it doesn't help much. Now if a person gets back some of their health, then they start exercising a bit....over time, they might get in better shape, be less constricted in their blood flow and yes, it would beneit them like any "normal" person, without a testosterone deficiency gets.
Anyway, it's obvious to me, now, that I am being vain, rather than trying to be able to bend, walk and avoid constant night sweats and the like. Thanks for your great insight. 😉
When I was in my late 50s, I experienced the male equivalent of menopause, especially night sweats and mood swings. What I didn't know was that I had also lost almost an inch of height! Low testosterone in men is a risk factor for osteoporosis. When I was tested, my testosterone was about halfway between low normal for a man, and high normal for a woman.
Testosterone replacement therapy and bone strengthening drugs have halted my bone loss, but not reversed it. I don't feel like Superman, and I don't have a raging libido. I just feel normal. My blood chemistry is checked several times a year, and is very good. There may be a tradeoff between quality of life now and heart problems later, but right now (I'm 70) I think it's worth it.
I guess what I'm trying to say is that there are benefits for an otherwise healthy man having testosterone replacement therapy, used appropriately, that outweigh the risks. Also consider that the men in this study were already sick.
You are a moron and have no clue what your talking about. I'm 47 yrs old and have been on pellet therapy for 2 years. My body stopped making natural testosterone and I was miserable. I had extreme fatigue, couldn't sleep, mood swings and other health issues. This treatment has changed my life in every completely. Vanity treatment, good one knucklehead, get informed or shut up.
The person under "Some Facts" – What you have said is totally absurd. Not only is your statement about men losing their testicles and not opting for replacement therapy wrong, but the idea that a man's health will be just fine is wrong. I have some personal knowledge on this subject for the last 30 years, and having discussed and talked the subject over (I am in the category of men losing their testicles) by dozens of experts – Urologists and Endocrinologists.
I am living proof that HRT has helped all my vitals. I undergo periodic blood tests and I can attest my health, weight, blood pressure, triglyceride levels, etc. has improved.
Just as the article said “You need to be careful about the conclusion you draw from this study,”
Disregard "Some Facts" post, and speak to your doctor (a reputable doctor), and then weigh the benefits and risks. Life is all about weighing the benefits with the risks. As a starter I have a link below that discusses an introduction
http://www.everydayhealth.com/testicular-cancer/testosterone-replacement.aspx
"Talk to your doctor" he's probably the dude who started you on it in the first place. In order for a physician to make a buck, he/she has to find something they can treat or possibly cure. A healthy person is a doctor's nemesis.
we have a long way to go before we can truly fine tune hormone production down to a precise accuracy. lot of trial and error to now and to come.
I think there is a distinction between necessary therapy like what I have and the treatments that older men get when not needed. It likely can harm the heart since men are not meant to have their levels stay up when older; naturally they are supposed to decrease with age. But, those like me who take it because we no longer make our own are simply replacing what the body made before. That should not be an issue.
So – I can choose between decreased sex drive/performance, increased fat, hair loss and general fatigue or an increased chance of stroke or heart attack. Basically, it's a choice between lower quality of life or an increased chance of death – dying slowly or quickly. Geez, nice options. Now I'm depressed.
Epidemiology in general is populated by ridiculous conclusions like this article. Bad science is the norm these days, while journalists are irresponsible in printing this garbage for consumption by the ignorant and fearful sheep.
Chronic "low T" can affect the heart as well. "low T" results in muscle loss in the body, which can weaken the heart. Perhaps this is a factor to consider in these studies as well. What is a percentage of heart problems for men with this condition?
Did you read the article at all? Men with "low T" having heart problems at 3 years post-study = 20%. Men with "low T" supplemented with "more T" having heart problems at same endpoint = 25%.
READ!
Maybe the heart problems are from the renewed sex activity. At 48 if I tried some of that raving sexual tyrannosaurus stuff I used to do I probably would have chest pains....There's no way I would consider jumping off the dresser any more!
A similar study indicated that 90% of those who pass gas are 50% more likely to feel decreased abdominal pressure than 80% of those who did not, and the study applied, surprisingly similar results for both men and women!
Please no more facts, my head is hurting. Do you mean I can't be young forever nor look like Superman??? I NEED A PILL OR SOMETHING!!! How will Big Pharma act when they can't sell this snake oil or in New Mexico Rattlesnake milk!!! My world is shattered that I may be reduced to Viagra alone for my ego!!! Weak d1cks of America take heart, your best friend is always your right hand or both if your really good!!! My Gracious!!!! Mr. Haney is turning in his grave!!!!
Hey Patrick your absolutely right, My level was lower than yours but since I am taking the T implants the number is higher, more energy to do everything I couldn't before. The biggest thing is that I don't need anti-depressants, BP, weight is lower and better general health and well being. Probably would of died sooner if I wasn't on this. If this is what it takes so be it.
JAG, amphetamines would do the very same things for you. It's nice feeling hopped up and alert and keeping weight off without even thinking about it.
This just makes me chuckle. I have no problem having it prescribed to someone who actually medically requires it. Women have had to deal with this forever, you know, menopause. It is what the body is designed to do. They gave women estrogen for years and then found out it was killing a good percentage of them early. Why would this be any different? It is simply a vanity and/or comfort issue in most cases and some males are just so vulnerable to that aggressive marketing.
Does it really need to be said? Alright then, I will......WELL, DUH!!!! Mess with the body's natural rhythm, you're playing with fire. Ask any woman who got hormone treatments during menopause, which caused a high chance of breast cancer later in life.
You're getting older. DEAL WITH IT.
Nat, hormone replacement therapy does NOT raise the chance of gynecological cancers in all women. It raises the rate in those women who are already susceptible. The trouble is in knowing who is and who is not. For those who are not susceptible, the replacement therapy is safe and lowers the woman's cardiac risks and her risk for developing osteoporosis. It's well worth it although continuing to have menses past 60 is less than desirable.
I thought this was already know (well maybe not the exact percentage). As I think I had heard it relates to red blood cell production. If your red blood cell count is normal then add testosterone you up red blood cells and apparently too many causes problems. BUT if your red blood cell was also low then adding testosterone isn't as big a problem. Another issue is that for some testosterone can cause or aggravate sleep apnea which in turn can cause heart issues. Like many things testosterone treatment is very good for some but not for others - you need to test the other areas and monitor after you start treatment.
Oh, the sky is falling. Stop being so childish; you're not less than, just because your wood is soft. Leave nature be.
Very odd that this article came out... I just turned 50 and had a heart attack.... AND I have been on Testosterone Treatment for about 4 months now..
I find it very disturbing that a group of learned researchers pretends that testosterone enanthate should be the same as native testosterone.
In the case of bioidentical testosterone the C 17 atom on ring D has OH and H attached to it, while the testosterone enanthate molecule has the configuration
OCO(Ch2)5CH3 attached to it instead of the OH group. The molecular weight of bioidentical testosterone is 288.42 while testosterone enanthate’s molecular weight is 400.59. The two formulas are shown in the top two lines here:
http://www.ncbi.nlm.nih.gov/pccompound/?term=teststerone
So, it is not surprising that testosterone enanthate acts like a blocker to the testosterone receptor as the wrong key occupies the testosterone receptors of the heart muscle, the brain and the arteries. We have a repeat performance of the Women’s’ Health Initiative where the wrong conventional synthetic hormones were used scaring women into using hormone replacement after menopause. Now the same mistake has been repeated for men so that the medical establishment can scare men into the belief that testosterone replacement would be bad for men in andropause, when in reality it is the testosterone with the attached rat tail (enanthate) that allowed Big Pharma to obtain a patent and market this non-fitting dangerous drug as a make belief replacement for low testosterone. The truth remains that any man with low testosterone should only be replaced with bioidentical testosterone. This has been proven to be safe by Harvard professor Dr. Morgentaler (Ref. 1), even for men with prostate cancer (testosterone stimulates the immune system).
Ref. 1: Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008
Disparaging claims regarding testosterone enanthate may mislead some into medically inappropriate choices.
Although many molecular variants of estrogen and progestins are legal for female HRT, only true testosterone is legal for male HRT in the U.S. Testosterone has a plasma half-life measured in minutes and is ineffective when consumed orally or injected.
It must be delivered gradually and if consumed orally it must be protected from immediate destruction on its first pass through the liver. The options are a liquid carrier that diffuses slowly through the skin, a biodegradable polymer implant or temporary replacement of the hydroxyl group in the 17 alpha position with some other molecule. That addition protects the combination from degradation but also makes it biologically inactive.
The added molecule is eventually hydrolyzed to yield the original active testosterone. A small added molecule such as acetate gives faster release, low storage in body fat and requires daily injection. Larger molecules require less frequent injection and can allow oral consumption in some fatty carrier.
Enanthate is simply the largest molecule in common use. The combination is biologically inactive. When the enanthate is removed one has true active testosterone once more.
the heart problems have long been suspected and you can have prostrate problems. doctors tell me there is a cancer concern? it looks like some doctors are over prescribimg the stuff, but then the advertising is off the charts. you will see some definitive stats rather soon.
Thanks for the LIES and deception JAMA. What a ridiculous and INCONCLUSIVE study. MEANINGLESS.
Wondfer how much TAX PAYER money this cost/wasted...UFB
If we are going to make vanity treatments illegal then all cosmetic surgery needs to go, Also all women's facial products since they are vanity treatments, I am sure I could carry this further but I hope this is enough to address the point. Vanity surgery and products are a multi billion dollar industry.
Conclusions about T therapy and increased heart disease are a bit premature. Other factors come into play. In reading various articles about male hormones I stumbled on some interesting concerns about male estrogen. It appears that old men convert a certain amount of their testosterone to estrogen which is known to potentially cause vascular inflamation. So, perhaps testosterone therapy should be accompanied with low doses of drugs such as anastrazole which keep excess estrogen in check. There are studies out there that have looked at cardiovascular risk and estrogen to testosterone ratios. Yes, I take one anastrazole tablet weekly along with my T therapy to keep the ratios in the supposedly safe range. My point here is that there seems to be a lot of other factors related to the T therapy that need to be considered.
This is too much like the scare story about omega 3 fats and prostate cancer. In each case both quartiles that were being compared were below the typical therapeutic level. The difference in actual blood levels were barely above the noise and the differences were of doubtful statistical significance.
One additional factor relating to testosterone is that some individuals convert it to estrogen more rapidly than others. Estrogen receptor activation has been implicated in both atherosclerosis plaque growth and several cancers.
Higher doses, use of DHT or synthetics that do not aromatize, aromatase inhibitors and SERMs are all relevant to proper male HRT. A site staffed with medical professionals should not blindly publish whatever flows down the wires.
Low testosterone levels can cause symptoms such as a decreased sex drive, mood swings, decreased energy, sleeping problems, and even erectile dysfunction. Studies have also linked low testosterone levels to depression in males.
http://primebody.com
Dear Sirs,
I am 72 years old and use Testosterone therapy for low T. However I am carefully monitored every 3 months especially for possible PSA increase and increase in the red blood count. Were I to take Testosterone continuously then my red blood cell count would go through the roof, my blood would greatly increase in viscosity and I would be in danger from a potential cardiac event. Therefore firstly I only use Testosterone therapy for 50% of the time, which allows the red blood cell count to correct itself and secondly I take 0.5 mg per week of Anastrozole which prevents excessive deterioration of testosterone to Estradiol.
By this method method I have been able to successfully use testosterone therapy and prevent potential cardiac events. Used correctly testosterone therapy can be very beneficial. Unfortunately many men use testosterone therapy continuously without the precautions I have outlined thereby putting themselves at risk. I was able to use this methodology thanks to the assistance of my former internist, Dr Tim Cook and my endocrinologist, Dr M. Llano.
I also would prefer using androgel 50 % of the time allowing rbc a chance not to clump together.
I get paid over $87 per hour working from home with 2 kids at home. I never thought I'd be able to do it but my best friend earns over 10k a month doing this and she convinced me to try. The potential with this is endless. Heres what I've been doing, w*w^w . Best96 . c^o*m-
I'm 75 and quite frankly am beginning to feel quite comfortable with myself. I have energy, full head of hair, 6' 184 lbs and little interest in sex. Even if interested it is a waste of time for me. So I guess I'll just have to be happy with being healthy and not a sex object anymore. Honestly, its a relief. The pressure is off to be superman. Hang in there guys things could be worse.
My body stopped producing testosterone and a doctor gave me the shot which was 10mo once every three weeks. as a result I got polycythemia Vera secondary I have to get 1 to 2 pints of blood removed every 6 weeks or die, I now have no testosterone because the doctors stopped the shot, I will always have polycythemia forever, Doctors dont know what to Di fir me since I need the testosterone. They started me on the t-patch now this week because I was so tired and my memory was being affected. Mayo's even is puzzled what to do me, but approved this new treatment for the next 3 months I dint care about phelbotomy's. I care about living and without testosterone my heart will eventually fail,
On January 31, 2014, the United States Food and Drug Administration (FDA) issued a Safety Announcement regarding testosterone products. This communication stated, "At this time, FDA has not concluded that FDA-approved testosterone treatment increases the risk of stroke, heart attack, or death. Patients should not stop taking prescribed testosterone products without first discussing any questions or concerns with their health care professionals. Health care professionals should consider whether the benefits of FDA-approved testosterone treatment is likely to exceed the potential risks of treatment. The prescribing information in the drug labels of FDA-approved testosterone products should be followed." While the beginning of this Safety Announcement might not seem alarming, the FDA further states, "None of the FDA-approved testosterone products are approved for use in men with low testosterone levels who lack an associated medical condition. FDA-approved testosterone formulations include the topical gel, transdermal patch, buccal system (applied to upper gum or inner cheek), and injection."
What is "an associated medical condition?" The manufacturers of some testosterone products would have one believe that Low T (the condition of having low testosterone levels) is an associated medical condition to the condition of having low testosterone. If you think this is strange logic, you would be correct. There are some who feel that the manufacturers of some testosterone products, realizing that they had a profitable "cure" for a disease that did not exist, simply invented a disease. Recent studies have shown that certain groups of men taking testosterone will have increased risks of stroke and heart attack. Lawsuits are now being filed against the manufacturers of some testosterone products and for failing to warn consumers about the deadly harm that testosterone can cause. Without getting technical, testosterone has been shown to increase the red blood count (thickening of the blood) which can cause clotting issues leading to stroke and heart attack.
If your physician has prescribed testosterone for you, you should immediately discuss whether you truly need it and whether there are safer alternative drugs. After weighing the risks and benefits, you and your physician can determine what drug, if any, is best for you. If you have suffered a stroke, you might want to consider a consultation with a lawyer.
Paul J. Molinaro, M.D., J.D.
Attorney at Law, Physician
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My husband was diagnosed with a testosterone problem and he didnt want to take injections. We are both super healthy and work out all the time and his doctor recommended a natural supplement called the Dr Max Powers Testosterone Boost. He's been taking this for 2 weeks now and I have even noticed a change in his energy and strength during our crossfit workouts (both in and out of the gym). Can't wait to see results further into taking this – definite for men if you're low on testosterone.
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