Testosterone and Your Heart

       Testosterone receives much more than its fair share of bad press. A few seconds on a search engine reveals it will shrink your penis, make you permanently sterile, cause multiple forms of cancer, destroy your heart, weaken your connective tissues, and make you go insane. But what does the data say? If you've looked, you'll know that testosterone has classically been considered a major cardiac risk but that attitudes are changing as we learn more about the pathologies of various cardiac issues and diseases.

       Recently, the media is piling on accusations of extreme cardiac risk associated with testosterone following the publication of a recent study and article. It's too bad for these sensationalists that the study was one of the worst designed ever and was roundly dismissed by most authorities. I won't link it here, but you can find it easily if you want it. Instead, lets look at studies designed to look at the issue in more detail.
    
       Fair warning: This post, in its entirety, is going to be a thick read. Skip it or skim it if you have not yet delved into the murky world of PED research. It's essentially a collection of hard data that I've been working through for a research project for my work. I'm not going to go into heavy detail on most since the papers themselves are satisfactory to explain the data. For the more research-minded among you I strongly urge at least a cursory skimming of the provided literature to get up to date on the current understanding of risk. For those of you just looking for broad summaries and interpretation, stick to the synopsis sections.

http://cardiovascres.oxfordjournals.org/content/57/2/370.short

Not much more to say here: "We found no evidence for cardiac toxicity of T administration despite a 10-fold increase in T levels after testosterone undecanoate administration compared to placebo administration. Neither infarct size nor procedure-related mortality was influenced by T status. In contrast, there was a tendency to an improved hemodynamic outcome..."

http://www.ncbi.nlm.nih.gov/pubmed/12800107

Visceral Abdominal Fat is a major risk factor for myocardial infarction, linking and perhaps superceding other risk factors and "linking" them for a larger effect. Estradiol is emerging as a major risk factor for myocardial infarction in men as well. This study concluded: "(1) VAT in men may largely explain the correlations of sex hormones, insulin, and obesity with the risk factors for MI measured, (2) VAT may be the principal factor in men, independently of other measures of adiposity, that links risk factors for MI to form the constellation, and (3) estradiol may play a more important role in the sex hormone-insulin relationship in men than has generally been considered."

http://circ.ahajournals.org/content/102/16/1906.short


Again, pretty clear: "Low-dose supplemental testosterone treatment in men with chronic stable angina reduces exercise-induced myocardial ischemia."


http://www.pnas.org/content/74/4/1729.short


Glucose metabolism dysfunction and estrogen elevations continue to be seen as primary cardiac risk factors. "The hypothesis is presented (i) that in men who have had a myocardial infarction, an abnormality in glucose tolerance and insulin response and elevation in serum cholesterol and triglyceride concentrations are all part of the same defect (glucose-insulin-lipid defect), (ii) that this glucose-insulin-lipid defect when glucose intolerance is present is the "mild diabetes" commonly associated with myocardial infarction but is based on a mechanism different from that of classical diabetes, (iii) that this glucose-insulin-lipid defect is secondary to an elevation in E/T, and (iv) that an alteration in the sex hormone milieu is the major predisposing factor for myocardial infarction."


http://www.ncbi.nlm.nih.gov/pubmed/3573299


http://www.sciencedirect.com/science/article/pii/S0140673676929688


Both of the two links above show estrogen elevations, with the second of these two having this to say:


"These results suggest that the hyperœstrogenæmia preceded the myocardial infarction and that hyperœstrogenæmia may be an important risk factor for myocardial infarction in men."


http://archinte.jamanetwork.com/article.aspx?articleid=601660


More about estrogen as a risk factor.


http://circ.ahajournals.org/content/99/13/1666.short


Reduction in exercise-induced ischemia with supplemental testosterone.


http://circ.ahajournals.org/content/100/16/1690.short


Testosterone induces coronary dilation and is shown to improve bloodflow in men with coronary artery disease.


http://cardiovascres.oxfordjournals.org/content/57/2/370.short


Reduced stress on the cardiac wall with testosterone doses sufficient to cause anabolism in diseased populations.


http://atvb.ahajournals.org/content/14/5/701.short


Low T hypothesized to be a risk factor for coronary atherosclerosis.


http://biomedgerontology.oxfordjournals.org/content/60/11/1451.short


Notable for it's conclusion that T did not significantly affect likelihood of cardiac events.


http://journals.lww.com/co-endocrinology/Abstract/2010/06000/Testosterone_and_heart_failure.14.asp


"Anabolic deficiency is a major component of the CHF syndrome and testosterone replacement therapy has been subject to recent trials."


There can never be enough research. We need much more to assemble a proper understanding of testosterone and associated cardiac risk. But here is a summary of what we know about it:


1. Obesity and metabolic syndrome are considered over-arching risk factors.


2. Elevated estrogen levels are beginning to be seen as primary instigators of cardiac issues in men, despite physiologic doses exerting positive effects.


3.Testosterone is being studied for its potential therapeutic uses in cardiac patients.


        There is and should be concern for health if you use PED's. These drugs carry risk and that should not be ignored. But when we look at the data, it’s easy to see that much of the fear mongering about testosterone and cardiac risk is just that. While some studies do highlight risk, it’s important to note that methodology and design alters the appearance of the data in many cases. The pieces above, and many more, support the idea that testosterone is not as dangerous to cardiac tissues, in most cases, as is often claimed. In fact, lifestyle factors such as metabolic syndrome and other hormones, estrogen and insulin chief among them, carry much more risk and affect cardiac tissue much more negatively. Until a full picture is assembled, continue to focus e on staying healthy via exercise and diet to maintain cardiac health, and be aware of how estrogen levels might affect your heart. It appears at this point that cardiac risk from testosterone has been overstated. The American Heart Association says TRT improves quality of life and carries minimal cardiac risk. Enough said.