Dr. John Day, Cardiologist

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Is Testosterone Safe for the Heart?

“Should I do it, doc?” Bob asked me during a recent clinic visit.  Bob was 54 years old and was hoping that testosterone supplements would be his miracle drug to increase energy levels, put on more muscle, and to help with erectile dysfunction (ED).

“This may put you at increased risk for a heart attack or a stroke,” I replied.

“I know and it worries me,” Bob responded.

While American men spend almost 2 billion dollars a year for testosterone supplements to feel young again, the FDA recently announced that testosterone increases the risk of heart attacks and strokes.  Does testosterone actually work and what are the cardiovascular risks?  In this article, I will share the results of two prominent studies that were just published to help answer Bob’s question, is testosterone safe for the heart?

Safe But Useless Unless Levels Are Very Low – TEAAM Study

The first of the two studies, the TEAAM Study, was just published in the prestigious Journal of the American Medical Association.  The TEAAM Study was a small but very well designed study from Harvard University.

Basically, Harvard researchers enrolled 308 men, age 60 or older, and then randomized them to either testosterone gel or a placebo gel daily for 3 years.  All of these men had low or low-normal testosterone levels.  The goal was to look at the effects of testosterone on general health, sexual function, and overall risk to the cardiovascular system.

After 3 years of using testosterone or a placebo, researchers unfortunately found that testosterone did not improve general health or sexual function.   However, this was not all bad news.  Fortunately, they did find that even after using testosterone supplements for 3 years there was no increase in atherosclerosis or coronary artery calcium deposition in the heart.

The take home message from this study is that while testosterone may be safe for the heart, it really doesn’t do any good unless your testosterone levels are really low (less than 100 ng/dL).

Testosterone Decreases Heart Attacks and Prolongs Life – VA Study

The second big testosterone study to come out was just published in the European Heart Journal.  This VA study was based on a retrospective review of 83,010 veterans from VA hospitals.  As this was a retrospective study, or basically just a medical “chart review,” the findings are no where near as reliable as the randomized TEAAM Study where the doctors and patients had no idea if they were using real testosterone or a placebo.

Thus, it is possible that the veterans taking testosterone in this study may have had a “placebo effect.”  In other words, if they believed the testosterone was helping them then it was possible that the benefit was entirely due to the power of the mind to heal them.  This is something that I have discussed in a previous blog article, 5 Ways to Heal Yourself With The Power of Your Mind (#62).  As a result, the findings of this study should be taken with the proverbial “grain of salt.”

Despite the limitations of this VA Study, researchers showed that in patients with documented low testosterone levels that testosterone supplements decreased the risk of a heart attack by 24%, decreased the risk of stroke by 36%, and decreased the risk of premature death by 56%.  The take home message of this study is that if your testosterone levels are low then testosterone supplements may not be as dangerous as other studies have indicated.

Should You Take Testosterone Supplements?

At the end of the day, these two recent testosterone studies just further “muddy the water” regarding testosterone supplements.  While I can’t recommend testosterone supplements, as this is something you should discuss carefully with your physician after weighing the risks and benefits, here is what I told Bob and my other patients who are considering testosterone supplementation.

1. Don’t even consider testosterone unless your levels are extremely low.

Regardless of your symptoms, testosterone is not worth the risk unless your levels are clearly low and you are having significant symptoms.  Like any other supplement, testosterone is no magical pill to feel young again or ward off disease.

2. Your cardiovascular risks are unclear.

While the two studies discussed in this article showed that testosterone is safe, and possibly even beneficial for heart health, other studies have shown the exact opposite prompting an FDA warning that testosterone may cause heart attacks or strokes.  For patients with active heart disease, I generally counsel against testosterone supplements unless levels are extremely low and the symptoms absolutely unbearable.

However, in patients with a well controlled heart condition, testosterone supplements may be safe.  Fortunately, the two recent studies are very reassuring when it comes to the cardiac risks of testosterone.

3. Boost your testosterone levels naturally

In my opinion, the very best way to boost your testosterone levels is to do so naturally with a healthy lifestyle.  For example, medical studies have shown that getting enough sleep, maintaining a healthy weight, getting regular exercise, managing stress, and eliminating unnecessary medications may all raise your testosterone levels.  Better yet, raising testosterone levels naturally will help all aspects of your life and will help to prevent other health problems.

Do you or a loved one have low testosterone levels?  What has worked for you?  Please leave your comments below for our community.