Pumping Up Low T (Testosterone) and the Risk of Heart Attack

A few weeks ago the FDA said that it is taking another look at the "safety of popular Testosterone drugs for men" prompted by studies published that indicated that using the hormone testosterone can increase the risks of heart attack, stroke and death.
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Many men, young, middle age and old, are pumping up their low T (Testosterone) levels by using one of the popular Testosterone treatments. Simply by using a Testosterone gel, cream or patch, they can pump up their muscles, their strength, their mood and their sex drive. Sounds like a fountain of youth!

But by pumping up their Testosterone levels, they may also be pumping up their risk for a heart attack, or even worse.

A few weeks ago the FDA said that it is taking another look at the "safety of popular Testosterone drugs for men" prompted by studies published that indicated that using the hormone testosterone can increase the risks of heart attack, stroke and death.

What studies are they referring to?

Well, a recently published study by Finkel et al. revealed that using Testosterone raised the risk of heart attacks in men >65 years as well as in men younger than 65 years who also had a history of heart disease.

I am sure that you have seen the commercial that describes a man with low energy, who is tired, moody and has a low sex drive. The commercial goes on to explain that the man may have a condition called "low T" which is short for low Testosterone. I sure that this commercial capture the attention of a lot of men, and women too.

So what's the story?

Testosterone is the male hormone that is produced naturally in the brain and testes and serves may functions including maintaining muscle mass and improving strength, maintaining libido and sexual drive, and maintaining male hair pattern, to name just a few. There are some men who don't have enough Testosterone and those are the men for whom the "low T" medication was designed and approved for.

More specifically, Testosterone treatments have been approved by the FDA for use in men who have a condition called hypogonadism.

Hypogonadism is a disease in which a man's body does not make enough of the male hormone, Testosterone. The cause can be due to inadequate functioning of the testicles or a problem with parts of the brain called the hypothalamus and pituitary. Hypogonadism results in a severe Testosterone deficiency that can be detected through a blood test that must be drawn in the morning, measuring the Testosterone level.

Now, Testosterone treatments have been used to treat decreased strength, weakness, endurance and libido particularly in older men who have had a decrease in their serum Testosterone associated with their age. In fact, according to an article, "Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests" written by Carnegie (Rev Urol. 2004; 6(Suppl 6): S3-S8), the prevalence of hypogonadism has increased in recent years. It has been reported that 12 percent, 19 percent, 28 percent, and 49 percent of men greater than 50, 60, 70, or 80 years of age, respectively, fit the criteria of hypogonadism.

As you can imagine, it has recently been observed that Testosterone has been used by younger and younger men (who doesn't want to be as strong and virile as possible) and by men who have not had their Testosterone hormone level measured to determine if it is low.

Sales of testosterone treatments have increased from a little over 1 Million prescriptions in the year 2000 to more than 5.3 million prescriptions in 2011 according to an article in the Journal of the American Medical Association. Testosterone, comes in several different forms including gels, patches, pellets to injections.

The study, "Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men" by Dr. William D. Finkle published in the journal PLoS ONE, looked at the rate of heart attacks in the 90 days following the initial prescription of testosterone and compared that to the rate of heart attack in the one year prior to the initial prescription of testosterone, in well over 55,000 men.

What did the researches find?

Among men aged 65 years and older, the authors observed a two-fold increase in the risk of heart attacks in the 90 days after filling an initial Testosterone prescription.

That is double the risk of a heart attack. Yicks!

The risk declined to baseline in the 91 to 180 days after the initial Testosterone prescription, that is, among those who did not refill their prescription.

Among younger men (< 65 years old) with a history of heart disease, the authors saw a two to three-fold increased risk of heart attacks in the 90 days following an initial Testosterone prescription.

There was no increase risk identified in younger men without a history of heart disease.

The authors, in their paper, point out that there have been several studies published in the last few years that have also demonstrated increased heart problems including heart attacks and death particularly in older men taking Testosterone.

Also, if you have a history of prostate or breast cancer, a high blood count (hematocrit > 55 percent), or a sensitivity to testosterone, you should absolutely not take Testosterone.

What to do if you are contemplating taking Testosterone?

Discuss your options with your doctor. Make sure you talk about your risk factors for heart disease (such as hypertension, diabetes, elevated cholesterol, family history of heart disease) and history of cancer. Discuss whether you should have the blood test for Testosterone and have a blood count checked.

Discuss other options that are available for decreased sexual function like the medications Viagra and Cialis or Levetra.

So, for the men in my life and in yours, I say, "Healthy and virile, yes. Death from a heart attack or stroke, no."

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