I do not want to be dismissive of primary care physicians (PCP) and most of the medical community, including the experts, the endocrinologists. The lack of understanding of HRT is incredibly high. Many if not most do not understand the symptoms, testing, treatment, and follow-up. They often undertreat, if treating at all. Depression is a common misdiagnosis. I do not blame them directly as they were never really educated on this. Yet I am disappointed that more physicians have not educated themselves about a major health issue for both men and women.
“Androgen deficiency (low testosterone) negatively affects the risk factors of cardiovascular disease in men with hypothyroidism.”
A January 2020 study (1) suggests: “Long-term androgen deficiency (low testosterone) in men with hypothyroidism is an important problem since it leads to concomitant cardiac pathology, which remains the leading cause of mortality in the world. The presence of different points of view on the problem of androgen deficiency (low testosterone) and its effect on the risk factors for cardiovascular disease in patients with hypothyroidism attracts attention.”
What did the researchers find? “The decrease of testosterone level in men with hypothyroidism is accompanied by an increase in the frequency of abdominal obesity, triglycerides and glucose escape (rise of blood glucose levels) and is associated with subclinical depression. In men with hypothyroidism and androgen deficiency (low testosterone), the average blood pressure in the daytime significantly exceeds the similar rates in patients with hypothyroidism and normal levels of testosterone.”
Research shows that the incidence of heart attacks, arrhythmias (like Atrial Fibrillation) are much less in patients with optimal T levels.
Conclusion: “The presence of androgen deficiency (low testosterone) negatively affects the risk factors of cardiovascular disease in men with hypothyroidism.”
For many years, doctors have been telling female patients NOT to take estrogen even when symptoms of menopause of discomforting and interfere with Quality of life. This came about due to speculation by researchers and the medical community. In addition, the Women’s Health Initiative back in 2001. This made the association between estrogen and breast cancer. However, in 2019, a review of that data revealed that the original conclusions were false. The association was from Progestin, synthetic progesterone, used in birth control pills. NO association was associated with Breast cancer. Yet many doctors still scare their patients about estrogen. Yes, there are estrogen receptor-positive breast cancers. But that is NOT the same as estrogen causing breast cancer.
The type of estrogen makes a difference. Topical Bio-identical estrogen is far safer than oral estrogens. One can develop Deep Venous Thrombosis (DVT) in the legs when oral estrogens are taken, like the risk of DVT from pregnancy and airline travel for extended periods. The leg clots are uncomfortable, but the real risk is those clots going to the lung, kidneys, or other organs leading to “infarcts” (death of some amount of tissue, permanent loss). DVT is not a simple problem. It often involves several months of blood thinners to resolve. Recurrence is not uncommon.
There is no question that when women exceed 50 years of age, around the time of menopause, that their cardiovascular risks rise rapidly. Most associate this with low estrogen levels but testosterone is important in this as well.
Overall sense of wellbeing.
Lower all-cause mortality, especially heart attacks and stroke.
Reduced severity of osteoporosis and lower incidence of fractures.
Improved memory and cognition.
Improved muscle mass, strength, and balance.
Improved libido/sexual desire…including orgasm.
Improved sleep and less depression.
Progesterone is important in HRT for women.
Improves premenstrual symptoms (PMS)
Promotes bone-building and helps to prevent osteoporosis.
By regulating estrogen, helps to protect against breast and uterine cancer.
Promotes the burning of fat which is used for energy.
Acts as a natural anti-depressant and eases anxiety.
Helps to keep blood sugar levels normal.
New research is coming to light which shows that the benefits of progesterone extend to breast health, cardiovascular health, and also the nervous system. Just treating women with estrogen is not enough. Testosterone and progesterone must also be considered.
This is probably the most misunderstood concept in HRT. Many physicians feel that TRT increases the risk of Prostate Cancer. Many if not most physicians think Estrogen cause Breast cancer. Both concepts are NOT based on scientific research.
The research is noticeably clear. The risk of breast cancer is NOT related to post-menopause Estrogen therapy. In fact, studies show that patients with low estrogen tend to have more cancers that are more difficult to cure. The research also shows us that low testosterone levels are associated with a GREATER risk of prostate cancer. In fact, men who have been treated for prostate cancer are eligible to go on TRT once they have passed the usual monitoring period…usually 2 years but some as soon as 6 months.
“The thyroid and its powerful hormones affect every single cell in your body. Ponder that for a moment. All systems, all tissues, all cells, everything. Your body is utterly dependent on thyroid hormones.”
Conclusion: “subclinical hypothyroidism is common in Erectile dysfunction patients and may be associated with Erectile dysfunction . . .Screening for thyroid dysfunction in men presenting with Erectile dysfunction is recommended.
The incidence of “sub-clinical” hypothyroidism is much more than previous thought. At IMC, we are more proactive about treating a potentially low thyroid state. We treat at lower TSH than most primary care physicians.
“However, doctors are discovering that even if a person’s results are within a “normal” range, the range is so broad that there could still be a problem. Also, not all doctors are familiar with thyroid problems or with interpreting the test results. This can lead to a person with hyperthyroidism being repeatedly misdiagnosed or disregarded by their doctor altogether.”
Metabolic syndrome (obesity, hypertension, diabetes, and high cholesterol) affects millions of Americans.
Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, strokes and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.
When you look at the condition, you see that these are all the risk factors associated with cardiovascular disease. There is no wonder that we have an “epidemic” (sorry for the sensationalism) of obesity in the US. As a result, we have some of the highest levels of heart and vascular disease in the world.
The most important treatment for this condition is self-driven. Weight loss, regular visits with your PCP to manage the current symptoms of high blood pressure and glucose levels. I strongly recommend any one over 50, and anyone who has risk factors for heart disease to take low-dose Aspirin (80mg/day).
Cardiac Risk Factors
Diabetes (type 1 or 2)
Strong family history of early heart disease/heart attacks/angina/other vascular disease (before age 50, immediate family).
It is well established, in men and women, that the incidence and severity of osteoporosis, and concomitant fractures, increases with age in men and especially women. Testosterone is the primary driver, but Estrogen is especially important for women in controlling/reversing or reducing the effects of osteoporosis. TRT improves muscle mass and strength, which is beneficial for the bones and joints. Estrogen is important as well, but the more important message is that you need all three components(T, E, and progesterone).
It is well established that Testosterone is a terrific stress modulator. In fact, when patients have a drop in their T level, while on HRT, it is often that they have been under greater emotional, intellectual, or physical stress. We just use it up faster when stressed. If you are spending more time in the gym, you should be feeling the improvement in strength and balance.
It is not uncommon for some clients to take a testosterone sublingual troche as a pre-workout routine or before stressful meetings or similar situations. The calming effect allows the client to be more focused, and less likely to respond emotionally.
The incidence of strokes and vascular disease is much higher in folks with low testosterone and estrogen is important in this regard for women. Vascular disease can affect all parts of the body. We assume if you have evidence of vascular disease in one place, you have it elsewhere. Kidney dysfunction, dementia/organic brain syndrome, and peripheral neuropathy are all potential risks.
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It could be said that testosterone is what makes men, men. It gives them their characteristic deep voices, large muscles, and facial and body hair. It plays a role in sperm production, fuels libido, and contributes to normal erections. It also fosters the production of red blood cells, boosts mood, and aids cognition.
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