There has been some debate about testosterone and high blood pressure. This article focuses on recent research, my clinical insights, and common sense.
High blood pressure is a major contributor to increased stroke and heart attach risk. This is simple physics. Viscous fluids behave differently under different pressures.
If you put thick fluid through tubing at high pressure, over time it can damage the tubing. Any plumber can understand this problem. That is why it is important to take a holistic approach when balancing hormones and individualize the treatment.
Alert! Learn more: Testosterone & Heart Disease, Heart Attacks, & Stroke Risk
The fact that testosterone levels decline with age and blood pressure tends to increase with age leads me to believe that testosterone therapy may help decrease blood pressure in some patients and this is what I’ve seen.
Getting In Touch With Your Feminine Side
Estrogen levels in men tend to increase with age due to a number of factors like increased body fat (the enzyme that converts testosterone to estrogen is in body fat). Men with diabetes or insulin resistance tend to convert more testosterone to estrogen than other men leading to a poor testosterone to estrogen ratio.
In an Italian study of 452 men, insulin resistance was highly correlated with increased estrogen levels in older men.1 This can lead to a downward spiral for some men because increases in estrogen production cause the body to decrease testosterone production due to a feedback loop.
The decrease in testosterone production due to increased estrogen levels may be the body’s way of protecting itself from excess estrogen. Yes, men produce a little estrogen and its good for us but when it increases too much it can cause problems.
In a meta study that pulled data from studies between 1969 and 2011, researchers found lower testosterone levels and higher estrogen levels increased the risk of heart disease and death from heart disease.2
A poor testosterone to estrogen ratio increased heart disease risk and death from heart disease in men. They also found that testosterone replacement therapy improved heart function.
Testosterone Therapy and High Blood Pressure
Testosterone THERAPY is very different from testosterone ABUSE. The heart is a muscle and it makes sense that muscles need ADEQUATE (not excessive) testosterone to function properly.
In testosterone ABUSE, men can have severe side-effects such as breast enlargement and increased heart risks. This is partly due to the fact that very high levels of testosterone cause VERY high levels of estrogen that are difficult to address.
Erectile Dysfunction and High Blood Pressure
Erectile dysfunction in some men may be due to excess estrogen causing a “leakiness” of the penis.3 The technical term is venous-leakage. Men are lucky in some ways because our erections can be an indicator of good health or health problems. Thus, looking for the cause of an erection problem is always a good thing.
It is no surprise that men with erectile dysfunction often have other signs and symptoms of heart and blood flow problems. In a major review of the data from several studies, researchers found that erectile dysfunction may be an early warning sign of future heart problems.13
The good news is that when we treat the cause (ie reduce estrogen levels or improve the testosterone:estrogen ratio) many patients notice an improvement in their overall quality of life and general health. Testosterone therapy in Seattle & Bellevue
Stroke Risk and Low Testosterone
Low testosterone also increases your risk of stroke or TIA (transient ischemic attack) if you’re over 70 years of age.8 Even if you are in the “normal” range, but on the lower end of normal, you are at increased risk for a stroke based on a 2009 study of 3443 men.
Testosterone can increase red blood cell synthesis. In men with low numbers of red blood cells this can be a good thing. In men with too many red blood cells there is a simple solution: donate blood every 3 months. This will help thin the blood and reduce stroke risk.
Women, before menopause, have a lower stroke risk than men. After menopause, women’s stroke risk equals that of men. This is likely due to the fact, at least in part, that women are no longer thinning their blood monthly after menses cease following menopause. Thus, donating blood can be a good thing for reasons beyond blood banks’ needs.
Sleep Apnea and Testosterone Therapy
Is testosterone therapy helpful to obese men with severe obstructive sleep apnea? Men with sleep apnea often have high blood pressure, weight gain, fatigue, erectile dysfunction, and high blood pressure.
A recent placebo-controlled study of 65 obese men found many benefits in just 18 weeks. These benefits included improved insulin sensitivity, reduced liver fat, decreased stiffness of blood vessels, improved oxygen uptake, and increased muscle mass.4
So is testosterone replacement therapy (TRT) safe in patients with obstructive sleep apnea (OSA)? This study concluded, YES:
“Cautionary statements about TRT in OSA appear frequently in the TRT literature and guidelines, despite lack of convincing evidence that TRT causes and/or aggravates OSA. Also, there is a lack of consistency in the findings connecting TRT to OSA. It is evident that the link between TRT and OSA is weak, based on methodological issues in many of the studies, and most studies involved small numbers of men. Further studies in this area are needed.”5
Sleep apnea, which means means difficulty breathing during sleep, can certainly increase the risk of heart problems and related issues. Sleep apnea may further decrease testosterone levels so addressing this can be important to help you find optimal health but treatments like the CPAP machine (helps with sleep apnea) only partially increase testosterone levels.6
I have had many patients come to my clinic suffering from low testosterone despite using the CPAP to improve sleep. Patients with sleep apnea may be at increased risk of heart attack.
Heart Attacks and Low Testosterone
A 2009 study in Japan showed that lower testosterone levels were related to increased heart attack risk in middle-aged men.7 Interestingly, atenolol, a high blood pressure medication, can lower testosterone levels which increases heart disease risk. Valsartan appears to be a better option as it has less chance of causing erectile dysfunction and is less likely to lower testosterone levels.
Vitamin T Helps With Weight Loss In Young And Old
Science Daily reviews recent research by Farid Saad, PhD that was presented at The Endocrine Society’s 90th Annual Meeting in San Francisco:
“All 95 men in the studies (ages 34 to 69 years) had the metabolic syndrome. To receive this diagnosis, patients must have three of the following five risk factors: increased waist circumference (abdominal fat), low HDL (“good”) cholesterol, high triglycerides (fats in the blood), high blood pressure, and high blood sugar.
The first study showed that testosterone treatment significantly reduced waist circumference, total cholesterol, LDL (“bad”) cholesterol, triglycerides, and body mass index (a measure of body fat). Treatment also increased “good” cholesterol. Improvements were progressive over 12 months, indicating that benefits may continue past a year, Saad said.
In the second study, the researchers divided the patient population into three groups by age: less than 57 years, 57 to 63 years, and more than 63 years. They found that the oldest men had similar improvements in metabolic risk factors to the youngest men.
Additionally, the investigators looked at the degree of testosterone deficiency before treatment. This beginning level of testosterone deficiency did not predict the beneficial outcome, they found. Men whose subnormal testosterone levels were not as low as the others had similar improvements in metabolic risk factors to men with the lowest levels, according to Saad.” Full Article
TAKE HOME MESSAGE: Testosterone therapy, when done correctly, reduces your risk of heart disease and improves heart function (the heart is a muscle).9,10,11
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