Testosterone and Heart Health

Did you know that testosterone deficiency (low testosterone) can impact men’s heart health?

According to a recent (May 2024) study published in the Annals of Internal Medicine…

Low testosterone in men was associated with an increased risk for all-cause mortality (death) while very low testosterone levels were associated with increased risk of cardiovascular death (1, 2).

In a systemic review and meta-analysis, researchers included 11 studies with more than 24,000 participants to analyze the associations of sex hormones with mortality and heart disease risk in aging men. According to the study authors, their data supported the hypothesis—and provided much-needed clarity—that hypogonadism (a condition where the male body is unable to produce normal amounts of testosterone, resulting in low testosterone) is associated with higher cardiovascular and all-cause mortality (3).

This is yet another reason why men—no matter their age—should know their testosterone level—even if it is to establish a baseline for future reference. Simply order your own testosterone and prostate panel—no doctor’s visit required—on sale until July 31st for $149.

In my article Testosterone and Men’s Health, I highlighted the vital role that testosterone plays in men’s health. I also discussed the physicatl and mental health consequences for men with low testosterone; why low testosterone is so prevalent—even among young men; and how to boost testosterone naturally.

Cause or Consequence?

When it comes to testosterone and men’s heart health…

Does having low testosterone cause increased risk of adverse cardiovascular events in men? Or is low testosterone a consequence of having coronary artery disease (CAD)?

Studies have suggested evidence for both.

However, the relationship between low testosterone and an increased risk of developing—or dying from—heart disease is neither simple nor direct. It is a complex and multi-factorial relationship.

One of the main causes of low testosterone levels is male hypogonadism, where the body is unable to produce normal amounts of testosterone, resulting in low testosterone,because of abnormal signaling hormones being released from the brain. For young, healthy men in their 20s, this signaling hormone rapidly messages the testes to make more sperm and testosterone. However, as men age and/or they experience chronic stress, their signaling hormones can lose speed, reducing the amount of testosterone being produced. Low testosterone symptoms can present as low libido (sex drive), changes in sleep patterns, difficulty concentrating, reduced muscle strength/muscle mass, decreased bone density, depression and fatigue.

Hypogonadism, characterized by low testosterone, is categorized as one of two types (4):

Primary. This type of hypogonadism is generally associated with a problem in the testicles, whether a congenital or genetic defect, testicular injury or trauma, autoimmune disorder or an infection affecting the testes (5).

Secondary. This type of hypogonadism is where low testosterone levels can be attributed to a problem in the hypothalamus or the pituitary gland, parts of the brain that signal the testicles to produce testosterone. This is a signaling issue, like a faltering Internet connection.

Secondary hypogonadism can be caused by pituitary disorders or by lifestyle factors, such as taking certain medications (e.g., opioids, anti-psychotics, antidepressants, etc.) that suppress testosterone production and/or having a chronic disease, like Type 2 diabetes, hypertension and/or obesity. (6)

Why Metabolic Health Matters

A common theme that underlines the association between low testosterone and increased cardiovascular risk in men is poor metabolic health.

“Metabolic health” is a term that describes how well we generate and process energy in the body (7). When we are metabolically healthy, the following 5 metabolic markers are at optimal levels—without the use of medications:

1. 1. 1. Blood sugar
      2. Triglycerides
      3. HDL “good” cholesterol
      4. Blood pressure
      5. Waist circumference

Metabolic health is also defined as the absence of “metabolic syndrome” (described below).

Each one of the conditions listed below individually increases your cardiovascular risk. However, “metabolic syndrome” consists of a group of conditions that, together, significantly increase your risk of heart disease, Type 2 diabetes and stroke.

If you have 3 or more of the following conditions, you are considered to have metabolic syndrome (8):

1. 1. 1. High blood sugar. Your fasting blood sugar is 100 mg/dL or higher.

1. 1. 2. Hypertriglyceridemia (high triglycerides). Your triglycerides are 150 mg/dL or greater.

1. 1. 3. Low HDL “good” cholesterol: For men, “low” HDL is less than 40 mg/dL; for women, “low” HDL is less than 50 mg/dL.

1. 1. 4. High blood pressure: Your systolic (top number) is 130 mmHg or higher and your diastolic (bottom number) is 85 mmHg or higher.

1. 1. 5. Large waist circumference. Greater than 40 inches (for men). Greater than 35 inches (for women).

In a 2018 study, published in Metabolic Syndrome and Related Disorders, researchers from the University of North Carolina at Chapel Hill analyzed data from 8,721 adults—consisting of men and women aged 20 and older—from the 2009 to 2016 National Health and Nutrition Examination Survey (NHANES).

What they found:  only 1 in 8 adults in the US—(just 12%!)—have optimal metabolic health (9).  Post-COVID, that percentage is likely even less.

 *Keep in mind: you can still be metabolically unhealthy even if you are at a “normal” weight.

 That said, poor metabolic health often goes hand-in-hand with being overweight or obese, which also increases risk of heart disease. According to the latest NIH statistics, among men aged 20 or older, 34% are overweight and 43% are obese (10).

And…being overweight or obese can lower testosterone levels in men.

How? There are two ways…

First, a large waist circumference (greater than 40 inches for men) indicates excess abdominal fat. An enzyme called “5-aromatase” is present in belly fat; and this enzyme is responsible for converting testosterone into estrogen (the female sex hormone). More belly fat = increased aromatase activity, which leads to an undesirable hormonal imbalance for men: less testosterone and more estrogen. This is why obese men typically have higher levels of estrogen than men who are of normal weight.

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What you can do

The best defense is a good offense. If you discover that your testosterone is less than optimal…that good news is that lifestyle modifications can help you raise testosterone levels naturally.

1.  Start by getting tested. Click here to order your own testosterone and prostate panel—no doctor’s visit required—on sale until July 31st for $149.

2.  Maintain a healthy weight or lose weight.

3.  Commit to lifestyle modifications that support metabolic health, including:

1. 1. 1. Food choices. Reduce consumption of ultra-processed foods; choose whole foods; reduce intake of refined carbohydrates, seed oils and sugar.
      2. Movement. Sit less. Lift weights. Interval train.
      3. Stress. Reduce!
      4. Sleep. Prioritize!
      5. Supplement. As appropriate.
      6. Endocrine-disrupting toxins.

4.  Get support. Feeling overwhelmed or confused about how to start making better food choices? Click here to schedule a FREE 15-minute Discovery phone consultation with me to see how I can best support you.

 

 

 

Sources

1, 3  “Low testosterone levels in men associated with mortality risk.” I.M. Matters from American College of Physicians (ACP). Endocrinology. May 14, 2024.

2   Yeap, B. B. et al. “Associations of Testosterone and Related Hormones with All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men: Individual Participant Data Meta-analyses”. Annals of Internal Medicine. Vol. 177, No. 6, pp. 768-781. June 2024.

4, 5, 6  Kumar P, Kumar N, Thakur DS, Patidar A. Male hypogonadism: Symptoms and treatment. J Adv Pharm Technol Res. 2010 Jul;1(3):297-301.

7  Means, C. (2020, June 18). “The Ultimate Guide to Metabolic Health”. Levels | Metabolic Insights.

8  “Metabolic Syndrome”. Cleveland Clinic. 9/13/23.

9  Araújo, J., Cai, J. and Stevens, J. “Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016.” Metabolic Syndrome and Related Disorders. Vol. 17, Issue 1, pp. 46-52. Feb. 2019.

10  NIH, National Institute of Diabetes and Digestive and Kidney Diseases. Overweight & Obesity Statistics.

11  Arnarson, A. “Can Boosting Your Testosterone Help You Lose Fat?” Healthline. June 13, 2023.

12  George JT, Millar RP, Anderson RA. Hypothesis: kisspeptin mediates male hypogonadism in obesity and type 2 diabetes. Neuroendocrinology. 2010; 91 (4):302-7.

13   Lee HK, Lee JK, Cho B. The role of androgen in the adipose tissue of males. World J Mens Health. 2013 Aug;31(2):136-40.