Testosterone Replacement and Heart Health
With an aging population hormone replacement therapy (HRT) has become increasingly common, especially testosterone replacement therapy (TRT). In this post we explore common indications for TRT, as well as the potential impact on heart health.
What is Testosterone Replacement?
Testosterone is a hormone that is responsible for a number of functions in both males and females. It affects fertility, libido, maintaining muscle mass and bone density as well as sense of well being and energy. The use of TRT is becoming increasingly common in an aging population to help achieve goals related to well-being, muscle mass, libido among others. Mostly commonly TRT is started for individuals with hypogonadism, where measured levels of testosterone are low.
How does TRT Affect the Heart?
Testosterone can affect the heart and cardiovascular system in a number of ways both directly and indirectly.
Testosterone commonly increases the red blood cell count and/or hemoglobin concentration. As hemoglobin increases, the blood becomes thicker or more viscous. As blood becomes more viscous, the blood pressure can rise. Regular checks of the blood count can be helpful to identify when the hemoglobin increases and when a blood donation may be helpful to lower the hemoglobin concentration.
Additionally, TRT can lower the HDL (“good cholesterol”), but it is unclear if it alters the LDL (“bad cholesterol”). Routine screening and monitoring of cholesterol is helpful to determine if a significant change occurs after starting TRT.
There is some evidence that testosterone may slow progression of atherosclerotic plaque in the heart, and higher testosterone levels are associated with lower heart disease risk in men over the age of 70. Additionally, testosterone therapy may improve metabolic health.
Are There Any Studies That Looked Into TRT and Heart Disease Risk?
Testosterone supplementation or replacement has traditionally been controversial in regards to cardiac health and previously, few studies existed to determine if TRT is safe or related to an increase risk of heart disease.
Testosterone supplementation in males with a high cardiac risk and hypogonadism (those with measured low testosterone levels) was studied in a randomized placebo-controlled trial (a type of trial that provides us with strong scientific evidence) in regards to cardiac risk, published in the New England Journal of Medicine. In that trial, men receiving testosterone replacement as a gel compared those receiving a placebo gel (gel without testosterone) had no increased risk of major cardiac events including death from cardiac cause, heart attack, stroke or needing heart stent or bypass surgery. There was a reported increase rate of abnormal heart rhythms such as atrial fibrillation.
It is important to note that the study only included men that have low testosterone levels and have a high cardiovascular risk profile. Additionally, the follow-up time for the study is only 3 years, therefore long-term affects are unknown.
How Can Testosterone Levels Be Increased Without Supplementation?
There are a number of ways to increase testosterone levels without supplementation including exercise, building muscle mass through weight training, healthy eating with a very low sugar, low processed carbohydrate diet such as Mediterranean diet, and avoiding alcohol intake.
All questions and concerns regarding testosterone replacement therapy and heart conditions and treatment should be discussed with a licensed provider. The information found here is educational only and is not meant as a consultation or a substitute for a consultation with your doctor.