Recent clinical research clearly indicates that men suffering from the condition of low testosterone are at greater risk for developing and dying from heart disease.  In one extensive study a group of European researchers examined over 40 years of journal published and peer-reviewed research (from 1970 to 2013) on heart disease and its relation to testosterone levels, in which a link between the two was conclusively demonstrated.

Heart disease is becoming a global epidemic – affecting a disproportionately large number of people within a community, region, or population at the same time.  According to the U.S. Center for Disease Control:

• Based on 2009 estimates, approximately 1 out of every 4 deaths (600,000) in the U.S. are due to cardiovascular disease.
• Using estimates as late as 2009, heart disease is the leading cause of death for both men and women, and more than half of these deaths occur in men.
• 2013 estimated data cites annual heart attacks in Americans at 715,000, of which 525,000 are a first heart attack, and 190,000 of which occur in prior heart attack victims.
• Based on 2011 estimates coronary heart disease costs the United States $108.9 billion per year, which also includes the cost of lost productivity, medications, and healthcare services. 

The high respected medical information website WebMD cites stroke as the third largest cause of death in the U.S., and cites a rate of one stroke victim every 45 seconds.  WebMD goes on to describe stroke as having accounted for more than 1 in 15 deaths throughout the U.S. during 2001, as a leading cause of disability.

Research on Low Testosterone and Heart Disease

Dr. Johannes Ruige, M.D., Ph.D., (study author and researcher) from Ghent University Hospital in Belgium was one of the researchers who identified links between low testosterone and atherosclerosis (a hardening and thickening of the walls within arteries) that makes sufferers more susceptible to heart disease, and eventual heart attacks.  Specifically, Ruige et al (and her colleagues) published a study entitled, ‘Endogenous testosterone and cardiovascular disease in healthy men: a meta-analysis’ in the June 2011 journal ‘Heart’ (the British Cardiac Society journal).  Dr. Ruige’s stated aims for the study were to estimate the predictive value of testosterone for cardiovascular disease, and to identify study features explaining conflicting results.  The researchers performed a meta-analytical study (secondary research conducted on several primary research studies) consisting of eligible population-based cohorts, and nested case-control studies on low testosterone in association with ischaemic heart disease, mortality and death, atherosclerosis, stroke, and myocardial infarction from coronary heart disease.  They clearly identified and selected nineteen potential articles (based on their predetermined study inclusion eligibility), and were able to find an independent with total testosterone levels.  Two variables, the age of study population and the year of publication, served as modifiers in the relationship between testosterone and cardiovascular disease.  The first was extended to include men who exceeded 70 years of age, and the second to measure subset data –  smaller within study groups used to breakdown the whole into segments.   Ruige, et al concluded that all studies published after January 2007 (their latter studies), demonstrated a particularly significant association (relationship) between heart disease and low testosterone, the results of which were confirmed through the separate analyses of bioavailable and free-testosterone.  In addition, Dr. Ruige went on to express the hope that less frequently investigated events might also be discovered as integral such as:  arrhythmia – a condition wherein there is a problem with the heart beat or rate; and thrombosis – a condition wherein a blood clot develops within the circulatory system.

In December of 2007 the journal Circulation published a study entitled, ‘Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study’ by KT Khaw, et al of the Clinical Gerontology Addenbrooke’s Hospital, Cambridge, UK.  Prompted by the (at the time) still controversial relationship between endogenous testosterone concentrations and health in men, the researchers’ cited aim was to examine the prospective relationship between endogenous (natural occurring within the body) testosterone concentrations and mortality (death rates) due to all causes of cardiovascular disease, and cancer in an 11,606 men study with age ranges from 40 to 79 years old.  Subjects were surveyed from 1993 to 1997, and then participated in a follow up survey in the year 2003.  The follow up revealed that 825 subjects without prevalent cancer or cardiovascular disease had died, and were compared with a control group that consisted of 1489 living (age matched) subjects matched with similar baseline date visits.  The researchers then adjusted for known variables including diabetes mellitus, systolic blood pressure, sex hormone binding globulin (SHBG), alcohol intake, physical activity, blood cholesterol, dehydroepiandrosterone sulfate, androstanediol glucuronide, date of visit, body mass index, age, social class, education, and cigarette smoking at which time it was determined that natural testosterone concentrations were inversely related to mortality due to 825 all causes deaths, the 369 cardiovascular disease deaths, and the 304 cancer deaths.  Researchers generated odds ratios with 95% confidence intervals and concluded that in their male subjects endogenous testosterone concentrations are inversely related to death due to both cardiovascular disease and all causes, and that low testosterone appears to be a predictive marker for those at high risk of death from heart disease.

Dr. Robert Davis, MD, is a full professor of urology who teaches at the University of Rochester, N.Y. believes that these findings make perfect sense.  Dr. Davis holds that low testosterone is a common condition in men with metabolic syndrome – a disorder that contains several risk factors among which are abdominal fat, high blood sugar, low HDL cholesterol, high blood-fat levels, and high blood pressure.  Dr. Davis says that he’s not surprised at this finding, and that research has shown the correlation between low testosterone-related metabolic syndrome, which is related to a variety of diseases such as heart disease, vascular disease, and diabetes.  He further contends that testosterone levels in men who knowingly have metabolic syndrome should be routinely checked, and that more physicians should recognize the importance of such testing.

Similarly Health-Related Low Testosterone Conditions 

Low testosterone is known to contribute to heart disease, but are men more susceptible to this disease for other reasons?  There is research which suggests that they are, and actually such research outlines many of the factors that make men more predisposed to heart conditions than women, and presents numerous other divides among male populations.

For example, studies like one by CR Gale, et al points out how intelligence plays a role in the development of heart disease.  Gale out of the MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK published a work in the July 2012 Journal of Epidemiology Community Health entitled, ‘Intelligence in early adulthood and subclinical atherosclerosis in middle-aged men: the Vietnam Experience Study’.  The aim of this study was to examine whether intelligence in early adulthood is directly linked with (higher or lower) risk of subclinical atherosclerosis in mid-life.  The study contained 4,286 male participants all of whom were US veterans, and who at the time of military enlistment had their intelligence measured (at the mean age of 20.4 years), and for whom ankle brachial index or ABI (a test used to predict the severity of peripheral arterial disease) was taken a second time at age of 38 during the medical exam by Doppler.  Researchers then adjusted their measures to account for several different variables among which were alcohol intake, education, age, triglyceride and glucose concentrations, erythrocyte sedimentation rate, body mass index, blood pressure, socioeconomic position, serum cholesterol, and smoking all of which had little or no effect on the results.  Gale, et al demonstrated that higher intelligence in early adulthood was definitely linked to a higher ABI in mid-life, which showed an increase in intelligence.

In addition to its capacity for promoting heart disease, low serum testosterone has also been linked to numerous quality of life diminishing symptoms.  Such hypogonadic (low testosterone) symptoms, which many physicians and researchers believe may serve as an early warning for a more serious life threatening conditions include:  an increased resistance to insulin; increasing overall body fat and fatty deposits; poor overall sleep quality, including the inability to get to, stay, and achieve latter (deeper and more satisfying) stages of sleep; a reduction in sexual performance, libido or arousal, the inability to achieve and or sustain rigid erections; reduced bone and muscle mass, along with diminished muscular strength; increased depression, anxiety, and irritability; diminished cognitive faculties such as concentration and focus, memory and recall, often described as brain fog; etc.  Testosterone replacement therapy administration (TRT) is being considered as a possibly viable treatment in more serious life threatening conditions, and has already been proven highly effective in remedying a wide range of symptoms as evidenced by the studies below:

• In November of 2012 XW Zhang, et al of the Department of Urology, Peking University People’s Hospital, Beijing, China published a study in the Chinese Medical Journal entitled, ‘Androgen replacement therapy improves psychological distress and health-related quality of life in late onset hypogonadism patients in Chinese population’.  They concluded that testosterone replacement therapy both improved a variety of hypogonadic symptoms, and comprehensively enhanced the improvement of psychological issues as well.
• In November of 2009 ES Andrade Jr., et al published a study in the Arquivos Brasileiros de Endocrinologia e Metabologia entitled, ‘Short term testosterone replacement therapy improves libido and body composition’.  The expressed aim this study was to examine the safety and efficacy of testosterone replacement in adult male subjects with late-onset hypogonadism.  After only eight weeks of therapy, the experimental group returned a greater decrease in waist circumference, greater sexual potency improvement, and greater libido improvement as compared to the control groups.
• In June of 2006 the European Journal of Endocrinology published a study by D. Kapoor, et al of the Centre for Diabetes and Endocrinology, Barnsley NHS Foundation Trust Hospital, Gawber Road, Barnsley, UK entitled, ‘Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes’.  The intended aim of this study was to examine the effect of testosterone replacement therapy on insulin resistance and glycaemic control in hypogonadal men with type 2 diabetes.  D. Kapoor, et al’s findings demonstrated that testosterone replacement therapy was responsible for both improving glycaemic control in hypogonadal men with type 2 diabetes, and reducing insulin resistance. Furthermore, they discovered marked improvements in visceral adiposity (loss of between organs body fat) and cholesterol, all of which when considered together represent a reduction in one’s risk for heart disease.
• In September 2003 Goldstat, et al of the Jean Hailes Foundation Research Unit, Clayton, Victoria, Australia published a study in the Journal of North American Menopause entitled, ’Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women’.  The purpose of this study was to examine the effects of testosterone replacement therapy (in transdermal form) on testosterone deficient women experiencing premenopausal physiological complications, which they more specifically characterized as libido, well-being, sexual function, and mood.  The conclusion reached by R. Goldstat, et al was that testosterone replacement therapy does significantly improve mood, well-being, libido, and sexual function in premenopausal women low testosterone.

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