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Low Testosterone

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Low Testosterone

Andropause Low TestosteroneThere is a lot of attention on testosterone these days. There are lots of Low T clinics popping up all over the place.

The issue is that low testosterone is a major health problem for both men and women. Testosterone has numerous benefits in the body. Ensuring optimal levels benefits health and performance.

Andropause is another name for Low Testosterone.

So, what are the symptoms of low testosterone and what conditions increase when testosterone is low?

 

Symptoms of low testosterone:

  • Increased heart attacks and strokes
  • decreased memory & intelligence
  • Increased dementia & alzheimer’s
  • Loss of drive & competitive edge
  • Stiffness & pain in muscles and joints
  • Falling levels of fitness
  • Decreased effectiveness of workouts
  • Sarcopenia
  • Osteoporosis
  • Anemia
  • Increased cancer
  • Fatigue, tiredness
  • Depression, mood changes, hopelessness
  • Irritability
  • Dysphoria
  • Reduced libido & potency: decreased desire & fantasies, decreased morning erections, decreased erectile tension, longer recovery times between orgasms, decreased intensity of orgasms

Testosterone levels tend to decline with age. However…

“We age because our hormones decline,
Our hormones don’t decline because we age.”
– Ron Rothenburg, MD

We also see:

  • Increased risk of diabetes & metabolic syndrome
  • Increased inflammation
  • Increased risk of cancer

Studies show that higher levels of testosterone are associated with lower mortality.

A 10 year prospective study with 11,606 men between the ages of 40 and 79 years validated this. In fact, they concluded that low testosterone predicts cardiovascular disease.[1] It should be noted that these were natural testosterone levels not levels in patients receiving testosterone replacement therapy.

In this study, men with a testosterone level above 564 (compared to 350) had a 41% lower chance of dying for any reason. Also, the risk of dying decreased 14% for every 173 point increase in testosterone. So, a testosterone level of 1000 compared to 300 had a 57% decreased risk of death.

But what about those patients who are receiving testosterone replacement therapy (TRT)? Does it lower their risk too?

A study of 1031 male veterans over the age of 40 years with a total serum testosterone level of < 250. 398 of these patients began testosterone replacement therapy. After 4 years of therapy, the mortality in the treated group was 10.3% while in the untreated group it was 20.7%. This was very statistically significant with a P of <0.0001. This means that there was less than a 0.1% chance that these findings were due to chance.[2]

Also of note in this study, prostate cancer in the testosterone replacement therapy group was 1.6% whereas it was 2.0% in the untreated group.

Higher levels of testosterone improve cognitive function

Lower testosterone levels are associated with lower cognitive function and testosterone replacement therapy improves this function.[3,4]

Testosterone Replacement Therapy (TRT) prevents the production of beta amyloid precursor proteins in men which are increased in Alzheimer’s Disease.[5,6]

In a study by Tan, 36 newly diagnosed Alzheimer’s patients had their serum testosterone levels measured. 10 of these 36 patients had a testosterone of <240. 5 of the 10 received testosterone replacement therapy (TRT) and 5 were given a placebo. The placebo group gradually deteriorated but the TRT group improved over 1 year.[7]

In patients with low testosterone, testosterone replacement therapy (TRT) is effective in improving mood when psych drugs don’t work.[8]

Testosterone Replacement Therapy increases nocturnal and spontaneous erections and improves mood.[9]

High free Testosterone levels were associated with better performance on tests of memory, executive function, and spatial ability and with a reduced risk for Alzheimer’s Disease as well as improved cerebral blood flow.[10]

Low testosterone in associated with Cardiovascular Disease Risk

The lower the testosterone and free testosterone the more likely there was CAD. Testosterone improves exercise induced ST depression. Testosterone dilates coronary arteries. Low testosterone is associated with dyslipidemia. Higher levels of endogenous testosterone are associated with a decreased risk of cardiovascular death.

Low-dose supplemental testosterone treatment in men with chronic stable angina reduces exercise-induced myocardial ischemia.[15]

Short-term administration of testosterone induces a beneficial effect on exercise-induced myocardial ischemia in men with coronary artery disease.[16]

Short-term intracoronary administration of testosterone, at physiological concentrations, induces coronary artery dilatation and increases coronary blood flow in men with established coronary artery disease.[17]

In men with CHF, 12 weeks of treatment with testosterone was safe, well tolerated, and led to significant improvements in physical capacity and symptoms.[18]

Testosterone replacement therapy improves lipid profiles and reduces inflammatory cytokines.[19]

There is an independent inverse association between levels of testosterone and aortic atherosclerosis in men.[20]

Total and free testosterone levels in men less than 45 years of age with coronary artery disease were significantly lower than those of controls. Free testosterone levels less than 17.3 pg/mL had a 3.3 times increased risk of premature coronary artery disease.[21]

There is an inverse relationship between testosterone levels and blood pressure.[22]

Low testosterone is associated with increased aging

Lower free testosterone was independently associated with frailty at baseline and follow-up.[23]

Testosterone is a major predictor of skeletal mass. There is improved strength without exercise but marked improvement with exercise.[24]

References:

  1. Khaw KT. et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men. Circulation. 2007;116:2694-2701
  2. Shores MM. et al. Testosterone Treatment and Mortality in Men with Low Testosterone Levels. J Clin Endocrinol Metab. 2012 Apr
  3. Alexander M. Swerdloff RS, Wang C, et al. Androgen-behavior correlations in hypogonadal men and eugonadal men. II. Cognitive abilities. Hormones and Behavior 1998; 33(2):85-94.
  4. Barrett-Conner E et al. Endogenous sex hormones and cognitive function in older men. J Clin Endocrinol Metab 1999 Oct:84(10):3681-5.
  5. Gouras GK et al. Testosterone reduces neuronal secretion of Alzheimer’s beta-amyloid peptides. Proc Natl Acad Sci USA 2000 Feb 1;97(3):1202-5.
  6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2390933/
  7. Tan RS. A pilot study on the effects of testosterone in hypogonadal aging male patients with Alzheimer’s disease. Aging Male. 2003 Mar;6(1):13-7
  8. Cooper MA. Testosterone replacement therapy for anxiety. Am J Psychiatry 157:1884, November 2000.
  9. Burris A et al. A long-term, prospective study of the physiologic and behavioral effects of hormone replacement therapy in untreated hypogonadal men. J Androl 1992 Jul-Aug;13(4):297-304
  10. Moffat SD, Resnick SM. Long-term measures of free testosterone predict regional cerebral blood flow patterns in elderly men. Neurobiol Aging. 2006 May 11.
  11. Shores MM, Moceri VM, Gruenewald DA, et al. Low testosterone is associated with decreased function and increased mortality risk: a preliminary study of men in a geriatric rehabilitation unit. J Am Geriatr Soc 2004;52:2077e81.
  12. Shaw KT, Dowsett M, Folkerd E, et al. 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. Circulation 2007;116:2694e701.
  13. Shores MM, Matsumoto AM, Sloan KL, et al. Low serum testosterone and mortality in male veterans. Arch Intern Med 2006;166:1660e5.
  14. Laughlin GA, Barrett-Connor E, Bergstrom J. Low serum testosterone and mortality in older men. J Clin Endocrinol Metab 2008;93:68e75.
  15. English KM, et al. Low-Dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina. Circulation 2000;102:1906-1911
  16. Rosano GM, et al. Acute anti-ischemic effect of testosterone in men with coronary artery disease. Circulation 2000 Feb 8;101(5):584
  17. Webb CM, et al. Effects of testosterone on coronary vasomotor regulation in men with coronary artery disease. Circulation 1999;100:1690-1696
  18. Pugh PJ, et al. Testosterone treatment for men with congestive heart failure. Heart Apr 2004;90(4):446-447
  19. Malkin CJ, et al. The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. J Clin Endocrinol 2004;89(7):3313-3318.
  20. Hak AE, et al. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men. J Clin Endocrinol Metab 2002 Aug;87(8):3632-9.
  21. Turhan S, et al. The association between androgen levels and premature coronary artery disease in men. Coron Artery Dis. 2007 May;18(3):159-62.
  22. Khaw KT, Barrett-Connor EJ. Blood pressure and endogenous testosterone in men: an inverse relationship. Hypertens 1988 Apr;6(4):329-32.
  23. Hyde, Zoe et al. Low free testosterone predicts frailty in older men: the health in men study. JCEM Vol 95, No 7.p 3165-3172.
  24. Bhasin S. The dose-dependent effects of testosterone on sexual function and on muscle mass and function. May Clin Proc. 2000 Jan;75 Suppl:S70-5.