Testosterone and Heart Health: What You Need to Know

Dr. Stephen Sinatra

Dr. Stephen Sinatra

08/12/2019

Most people know low testosterone levels can affect libido and sexual function. But did you know low testosterone is linked to heart problems, including heart attacks?

In a 2011 study published in the Journal of the American College of Cardiology, researchers analyzed testosterone levels in 2,416 men ages 69 to 81 over a five-year period. They found that men with the highest testosterone levels had a 30% lower risk of having a cardiovascular event than those with lower levels. 

While the researchers quickly cautioned men to not rush out and take testosterone in order to prevent a heart attack, it does illustrate the important role this hormone plays in heart health.

Low Testosterone and Heart Problems

The heart and blood vessels contain numerous testosterone receptor sites, suggesting this hormone is meant to support these body parts. Plus, low testosterone is associated with many heart risk factors, including obesity, metabolic syndrome, type 2 diabetes, and inflammation.

Research has also demonstrated that men with low testosterone have a higher incidence of developing heart failure or having a stroke. And a study published in the Journal of Clinical Endocrinology demonstrated that men with low testosterone have an increased risk of developing coronary artery disease. 

Low Testosterone Is a Widespread Issue

As important as testosterone is, having low testosterone is a real issue—especially as men age. Testosterone production normally increases during puberty, peaks at age 30, and declines at a rate of 1-2% per year after age 30.

Left unchecked, an 80-year-old man can have half as much testosterone as he did at age 30. Although, men of any age can develop low testosterone—especially those who are obese or have diabetes.

As a cardiologist, this concerns me greatly. My son Dr. Drew Sinatra, a naturopathic doctor, has a lot of experience treating low testosterone. So, I wanted to share his important advice with you.

Symptoms of Low Testosterone

Low testosterone symptoms can include:

  • Low libido and sexual function
  • Loss of muscle strength
  • Loss of body hair
  • Cognitive decline
  • Depression
  • Fatigue

Additionally, a European study of 3,369 men ages 40-79 concluded that there are three cardinal symptoms that are most likely to be related to low testosterone: erectile dysfunction, reduced sexual desire, and a loss of morning erections. 

If you are a man experiencing symptoms of low testosterone, I recommend asking your doctor about testosterone testing.

Testing for Low Testosterone

To make sure you have enough testosterone, your physician needs to test for both total testosterone and free testosterone—which is the amount of biologically available testosterone that your body can actively utilize.

You should check your testosterone levels in the morning since this is when levels are usually at their highest. I also recommend having your blood tested again within two weeks because hormone levels can fluctuate.

Do You Have Enough Testosterone?

Different labs have varying reference levels for total testosterone. The overall level considered “within normal range” is usually between 300-1200 ng/dl. For nonmedicated males, I like to see the total testosterone around 600 ng/dl. For males taking testosterone, I like to see the range from 700-900 ng/dl.

When looking at hormones, it’s also important to get the “full picture” to determine which hormones are out of balance. Ideally, you want to ask your doctor to test your DHEA, pregnenolone, cortisol, estradiol, and sex-hormone-binding globulin (SHBG). Knowing the values for these hormones can help your physician to understand the root of the issue, and which hormone pathway needs to be addressed.

Should You Get Testosterone Replacement Therapy?

Testosterone replacement therapy (TRT) for some men has definite advantages, especially for men experiencing quality-of-life issues, such as a decline in libido and sexual performance, decreased muscle and bone mass, and depression and/or decline in cognitive function. Plus, some doctors will consider giving TRT for men with test results consistently below 300 ng/dl for total testosterone.

To determine if you need TRT, it’s important to see a specialist who specializes in hormone replacement therapy. This isn’t something you can, or should, decide by reading articles or researching online since you will often encounter conflicting advice. TRT is not a “one size fits all” therapy—every patient is different.

In general, TRT appears to be quite safe and well-tolerated especially if your doctor starts you off slowly with a low dose, and regularly monitors blood levels of testosterone and other hormones, liver enzymes, and hematocrit (volume of red blood cells).

But be aware that TRT may have a downside. A literary search did lead me to a cohort study from 2014 showing that TRT led to an increased risk of a heart attack in men over the age of 65 with a preexisting heart condition. Talk to your doctor first about the pros and cons of starting TRT. As with any drug therapy, side effects can occur.

Regardless of whether TRT is an option or not, maintaining healthy testosterone production through proper diet, weight loss, high-intensity exercise, and supplements is safe and effective, and may help protect your heart and cardiovascular system.

Natural Testosterone Boosters that Support Heart Health

  • Do “natural testosterone booster” exercises. Exercising at the gym with fewer reps and heavier weights, engaging large muscle groups via squats or bench press, and practicing high-intensity exercises like quick sprints with a moderate rest period in between are all helpful for building endogenous testosterone and human growth hormone. But before you begin a new exercise program, you want to clear that with your doctor first. Plus, any man over the age of 40 should strongly consider getting an exercise stress test first.
  • Lose weight. Several studies show that men with low testosterone have an increased percentage of body fat. If weight gain is an issue, decrease your intake of sugar and simple carbohydrates. Plus, consult with a nutritionist and exercise trainer to come up with a weight loss program.
  • Reduce stress. High levels of the “stress” hormone cortisol are associated with low testosterone in athletes during training. Chronically elevated cortisol levels may negatively affect testosterone levels, so take time to meditate, laugh, practice qi gong or tai chi, or engage in other activities to reduce stress in your life.
  • Eat healthy fats. Your body needs good fats, particularly monounsaturated fats, to increase testosterone production. Eat avocadoes, coconut oil, salmon, or grass-fed beef.
  • Avoid xenoestrogens. These chemical compounds that can be found in such things as plastics, pesticides, and BPA can mimic estrogen, binding to estrogen receptors in the body. Too much estrogen in men is not a good thing.
  • Decrease your alcohol intake. High amounts of alcohol have been shown to alter testosterone production in several ways, including causing hormonal dysfunction, oxidation, and possible cell damage.

There are also several supplements that may help to increase your testosterone levels naturally and help with related symptoms. These include zinc (30 mg daily), ashwagandha (500-800 mg daily), Tribulus (500 mg daily), and sodium D aspartate (2000 mg daily). Plus, curcumin (500 mg daily) supports nitric oxide production, which may assist male sexuality.

Dr. Stephen Sinatra

Meet Dr. Stephen Sinatra

Dr. Stephen Sinatra is a highly respected and sought-after cardiologist and nutritionist with more than 30 years of clinical practice, research, and study. His integrative approach to heart health focuses on reducing inflammation in the body and maximizing the heart's ability to produce and use energy.

More About Dr. Stephen Sinatra

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