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January 10, 2012

Cardiovascular Disease Linked to Treatments that Lower Testosterone

The Ill Effects of Lower Testosterone Levels

This video with Drs. Samadi and Siegel of FoxNews illustrates the connection between treatments that lower testosterone and cardiovascular disease.  It’s been conventional wisdom in medicine that testosterone causes cardiovascular disease and prostate cancer.  Well, we now know the testosterone does not cause prostate cancer.  In fact, in might even protect against it.  Plus, it’s now recognized that males with low testosterone get more aggressive forms of prostate cancer than men with healthier levels.

The same scenario applies to cardiovascular disease.  It was once thought, and still commonly thought, that testosterone causes or contributes to heart disease.  This is primarily based on the observation that men get heart disease more than women.  What’s the difference between men and women. TESTOSTERONE (though women have some testosterone).  So testosterone must be the problem. Right? As Lee Corso says on ESPN GameDay, “not so fast my friend”.

In reality the incidence of heart disease and strokes goes up in men at a time when testosterone levels begin to decline past a critical threshold (which is different for each man).

In men with metastatic prostate cancer, that is prostate cancer that has spread to other parts of the body, a long-proven treatment to control it is to lower testosterone levels.  In the old days that meant surgical castration.  OUCH!  Today it’s done with hormonal manipulation that causes testosterone levels to plummet. But that still hurts.

Emerging studies are showing that men with metastatic prostate cancer who have received treatments that lower testosterone are at a far greater risk of heart disease and stroke.  This is consistent with previous studies that show that men with natural levels of testosterone on the higher end of the reference range are less likely to die from cardiovascular disease and cancer. In addition, men who receive testosterone lowering treatments, or androgen suppression therapy also become frequently depressed as the brain needs some testosterone to optimally function. These men also become fatigued, see an increase in body fat, and a loss of muscle mass.

In the post, “PSA and the US Preventive Services Task Force”, Dr. Paul discussed the findings and recommendations of the US Preventive Task Force that PSA use be curtailed.  One potential fallout from not doing PSA testing on men that it is likely that more men will be diagnosed with prostate cancer too late, when it already has spread beyond the prostate. Thus these men will be subjected to treatments that lower testosterone increasing their risk of cardiovascular disease.  The PSA is not a perfect test, but remains the best screen currently available along with a digital rectal examination.

So it is now appearing that it is too low of testosterone that may be the real problem in the development of cardiovascular disease. In the tomorrow’s post we will discuss the cardiovascular literature that shows that low T is not good for the heart and that administration of testosterone improves blood flow to the heart, and helps to reduce other cardiovascular risk factors.

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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