Now LOW T more likely to cause heart attacks

[thisAngelBites]

Study Links Sex Hormone Levels in the Blood to Risk of Sudden Cardiac Arrest

[davidtheman100]

Study Links Sex Hormone Levels in the Blood to Risk of Sudden Cardiac Arrest

You really can't win though, can you? For TRT the risks also include you being more prone to heart attacks as well.

"One testosterone study published in January 2014 found increased heart attack risk in men who used testosterone. The risk did not only apply to older men. But men young than 65 with pre-existing heart disease had “a twofold increase in risk of nonfatal heart attack shortly after initiation of testosterone therapy ,” according to the study."

[fit2bOld]

I'll take my chances.

[GirlyGymRat]

I like my sex hormones

[kelkel]

You really can't win though, can you? For TRT the risks also include you being more prone to heart attacks as well.

"One testosterone study published in January 2014 found increased heart attack risk in men who used testosterone. The risk did not only apply to older men. But men young than 65 with pre-existing heart disease had “a twofold increase in risk of nonfatal heart attack shortly after initiation of testosterone therapy,” according to the study."

Post the study if possible. I believe you are thinking of the one that was totally and collectively debunked by basically all the top docs in the industry.

I searched it up:

Response To Media Reports Associating Testosterone Treatment With Greater Heart Attack Risk - Life Extension

[davidtheman100]

okay

[Euroholic]

Id rather have a heart attack with a body pumped full of hormones than with out.

[lovbyts]

It's still 100x lower risk for heart attack or any sides compared to 99.99% of all the other FDA approved drugs out there.

There is also quality of life and that is proven by most people here on HRT vs those who arent. I still have a hard time believing there are not 50x more who have a heart attack due to low T.

[thisAngelBites]

You really can't win though, can you? For TRT the risks also include you being more prone to heart attacks as well.

Yes, that's why I posted this - one month high T causes MI, the next month, low T causes MI. I thought it would provide some balance for other studies posted that found exogenous testosterone (mostly poorly managed treatments, as far as I saw) caused cardiovascular problems.

It might be the case that both high and low testosterone levels are problematic - most hormones seem to work that way.

In the end I think human being are such complicated systems that deriving simple, blunt rules won't work that well. At least not until we understand the physiologic processes of the body better.

[thisAngelBites]

FYI, this article was about LOW T increasing cardiac risk.

[lovbyts]

Its better to burn out than fade away.

[marcus300]

Id rather have a heart attack with a body pumped full of hormones than with out.

your just a skinny arse fuker full of hormones who doesn't know how to train or eat correctly, a heart attack would be the best thing for you - cvnt

[marcus300]

19 August 2014

Testosterone Treatment and Heart Attack Risk

- New study shows testosterone treatment can even be beneficialTestosterone Treatment and Heart Attack Risk Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy . Baillargeon, J., et al., Ann Pharmacother 1060028014539918, first published on July 2, 2014 as doi:10.1177/1060028014539918, 2014

Testosterone therapy has been in use for more than 70 years for the treatment of hypogonadism, also called testosterone deficiency.1 In the past 30 years there has been a growing body of scientific research demonstrating that testosterone deficiency is associated with increased body weight/adiposity/waist circumference, insulin resistance, type 2 diabetes, hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased risk of mortality.2, 3 In line with the detrimental health outcomes seen with testosterone deficiency, testosterone therapy has been shown to confer beneficial effects on multiple risk factors and risk biomarkers related to these clinical conditions.4

Despite these well-documented health benefits, testosterone therapy is still controversial, in large part due to a few flawed studies about potential elevated myocardial infarction (MI) risk with testosterone therapy. On July 2, 2014, a study was published which demonstrated that testosterone therapy is not associated with an increased risk of MI, and may actually confer protection against MI.5
Key Points


Testosterone deficiency is associated with increased body weight/adiposity/waist circumference, insulin resistance, type 2 diabetes, hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased risk of mortality.2
Testosterone therapy beneficially impacts multiple risk factors and risk biomarkers related to highly prevalent clinical conditions that are associated with testosterone deficiency.4
The most recent study reported in this editorial demonstrates that testosterone therapy does not increase risk of MI, and that it actually may protect against MI in high-risk population.5 This is in line with a large body of research showing beneficial effects of testosterone therapy in hypogonadal men.4
Three large meta-analyses specifically focusing on identifying potential adverse effects of testosterone treatment report no significant increases in cardiovascular risk.6-8
A review of all testosterone trials up to 2012 found that testosterone therapy in patients with preexisting cardiovascular conditions, the effect on disease markers has typically been either neutral or beneficial, and does not increase the incidence of cardiovascular events.9

What is known
To the contrary of the large body of evidence supporting beneficial health effects of testosterone therapy in hypogonadal men, two recent studies reported that testosterone therapy is associated with an increased risk of heart attack, stroke, and death.10, 11 The first study, by Vigen et al published in JAMA on November 6, 2013, used a complicated questionable new statistical approach which reversed the actual results demonstrating a benefit for men treated with testosterone.11 This study has undergone two corrections, with such large data errors that 29 medical societies have called for retraction of the study as it is “no longer credible”.12, 13

The second study, by Finkle et al published in PLoS One on January 29, 2014, was a retrospective study of a health insurance database that reported rates of non-fatal myocardial infarction in up to 90 days following a testosterone prescription, and compared this to MI rates in the prior 12 months. The authors reported the rate ratio of MI post-prescription to pre-prescription was 1.36, and the rate in men older than 65 years was 2.19.10 However, the investigators presented the pre-prescription MI rate as if it reflected the natural history of MIs in the study population prior to treatment. This was not the case, because there was no run-in period to determine the natural history of untreated T deficiency. The study group was selected on the basis of having already received a T prescription. This means the pre-prescription MI rate reflects how often healthcare providers were willing to prescribe T to men with a recent (within 12 mo) MI. Any reluctance to prescribe T to men with recent MI would result in a reduced pre-prescription MI rate. Thus, the study substituted physician prescribing patterns for naturally occurring MI rates. This is a serious methodological error. Unacknowledged by the authors, observed MI rates after T prescription were actually substantially lower than predicted by the National Institutes of Health Heart Attack Risk Calculator.14

These two studies received widespread media attention, and created a new concern regarding cardiovascular risks with T prescriptions, with little attention paid to the critical methodological flaws in these studies, nor the large number of prior studies showing beneficial cardiovascular effects of testosterone therapy.
What this study adds
The latest study on testosterone therapy and MI by Baillargeon et al, published July 2, 2014, examined the risk of MI in a population-based cohort of older men receiving intramuscular testosterone.5

In a sample of 25,420 US Medicare recipients aged 65 y and older, a group of 6355 men treated with at least 1 injection of testosterone between January 1, 1997, and December 31, 2005 were matched to testosterone non-users. After adjusting for demographic and clinical characteristics, receipt of testosterone therapy was not associated with an increased risk of MI (hazard ratio [HR] = 0.84; 95% CI = 0.69-1.02).

Interestingly, a significant trend towards reduced MI rates with T administration was noted with increasing quartiles of risk. For men in the highest prognostic MI risk quartile, treatment with testosterone therapy was associated with significantly reduced risk (HR = 0.69; 95%CI= 0.53-0.92). A dose-response analysis demonstrated no increased risk in MI according to estimated cumulative dose of testosterone. While using a retrospective approach, this study adhered to well-established methodology and statistical analysis, in contrast the study by Vigen.

The study concluded that older men who were treated with intramuscular testosterone do not appear to have an increased risk of MI. For men with high MI risk, testosterone use is actually protective against MI. This conclusion is in line with previous studies showing that testosterone treatment in men over 40 years of age is associated with decreased mortality compared with no testosterone treatment.16, 17

These results are also consistent with three large meta-analyses that specifically focused on identifying potential adverse effects of testosterone treatment, and reported no significant increases in cardiovascular risks.6-8 A more recent review of testosterone trials found that testosterone therapy in patients with preexisting cardiovascular conditions, the effect on disease markers has typically been either neutral or beneficial, and does not increase the incidence of cardiovascular events.9

An insightful quote from the paper "Testosterone and cardiovascular risk: world’s experts take unprecedented action to correct misinformation" elegantly illustrates the scientific reality:13 "Science is complex, and there will always be articles published that yield unexpected or awkward results. Every once in a while, though, it is important for the research and clinical medical community to stand up and say, ‘‘No! This is wrong!’’ We do this for science, for the integrity of medical literature, and most importantly, we do it for the health and welfare of our patients."
References
1. Nieschlag E, Nieschlag S. Testosterone deficiency: a historical perspective. Asian journal of andrology. 2014;16(2):161-168.
2. Traish AM. Adverse health effects of testosterone deficiency (TD) in men. Steroids . 2014.
3. Mesbah Oskui P, French WJ, Herring MJ, et al. Testosterone and the cardiovascular system: a comprehensive review of the clinical literature. Journal of the American Heart Association. 2013;2(6):e000272.
4. Traish AM. Outcomes of testosterone therapy in men with testosterone deficiency (TD): Part II. Steroids. 2014, published online May 24, 2014.
5. Baillargeon J, Urban RJ, Kuo Y-F, et al. Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy. Ann Pharmacother 1060028014539918, first published on July 2, 2014 as doi:101177/1060028014539918. 2014.
6. Calof OM, Singh AB, Lee ML, et al. Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. The journals of gerontology Series A, Biological sciences and medical sciences. 2005;60(11):1451-1457.
7. Fernandez-Balsells MM, Murad MH, Lane M, et al. Clinical review 1: Adverse effects of testosterone therapy in adult men: a systematic review and meta-analysis. The Journal of clinical endocrinology and metabolism. 2010;95(6):2560-2575.
8. Haddad RM, Kennedy CC, Caples SM, et al. Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clinic proceedings Mayo Clinic. 2007;82(1):29-39.
9. Carson CC, 3rd, Rosano G. Exogenous testosterone, cardiovascular events, and cardiovascular risk factors in elderly men: a review of trial data. The journal of sexual medicine. 2012;9(1):54-67.
10. Finkle WD, Greenland S, Ridgeway GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PloS one. 2014;9(1):e85805.
11. Vigen R, O'Donnell CI, Baron AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels . JAMA : the journal of the American Medical Association. 2013;310(17):1829-1836.
12. Morgentaler A. Letter to JAMA Asking for Retraction of Misleading Article on Testosterone Therapy. Availible at Letter to JAMA Asking for Retraction of Misleading Article on Testosterone Therapy, accessed July 2, 2014. Androgen Study Group (ASG) 2014.
13. Morgentaler A, Lunenfeld B. Testosterone and cardiovascular risk: world's experts take unprecedented action to correct misinformation. The aging male : the official journal of the International Society for the Study of the Aging Male. 2014;17(2):63-65.
14. NIH. Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack. http://cvdrisknhlbinihgov/calculatorasp, accessed April 21, 2014.
15. Morgentaler A. Testosterone, cardiovascular risk, and hormonophobia. The journal of sexual medicine. 2014;11(6):1362-1366.
16. Shores MM, Smith NL, Forsberg CW, et al. Testosterone treatment and mortality in men with low testosterone levels. The Journal of clinical endocrinology and metabolism. 2012;97(6):2050-2058.
17. Muraleedharan V, Marsh H, Kapoor D, et al. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. European journal of endocrinology / European Federation of Endocrine Societies. 2013;169(6):725-733.

[marcus300]

9 April 2014

The role of testosterone in cardiovascular health

Capsules and medical form Testosterone and the cardiovascular system: a comprehensive review of the clinical literature. Mesbah Oskui P, French W, Herring M, et al. J Am Heart Assoc 2013; 2: e000272

This summary gives an overview of a comprehensive review of studies that have examined the association between testosterone levels and cardiovascular health.1 The review focuses on the role of testosterone in cardiovascular diseases, including the incidence of coronary artery disease (CAD), congestive heart failure (CHF), and heart-rate-corrected QT (QTc) length prolongation. The role of testosterone on risk factors for atherosclerosis, including type 2 diabetes mellitus (T2DM), obesity, and inflammation, are also reviewed. Findings from studies that investigated the use of testosterone replacement therapy (TRT) on cardiovascular diseases in men with testosterone deficiency (TD) are summarized and possible mechanisms of action (MoA) for testosterone with respect to these outcomes are discussed.
Key Points


Testosterone levels are inversely associated with severity of CAD,2,3 which may be improved by TRT


In men with CAD, both acute and chronic TRT improved myocardial ischemia by prolonging time to exercise-induced 1-mm ST-segment depression (by 68–108 seconds)4,5
Stepwise administration of testosterone in eugonadal men with CAD increased angina threshold by increasing vasodilation and coronary artery blood flow by 4.5% and 17.4% versus baseline6
The exact MoA is unknown, but testosterone may cause vasodilation via potassium channel opening7 and/or inactivation of L-type voltage-operated calcium8 channels in smooth muscle cells, or by modulation of nitric oxide release9
Animal studies suggest that the MoA may be non-genomic and endothelium independent10
Testosterone levels are significantly associated with CHF, which often presents as progressive worsening of exercise capacity in patients


In a study of 208 men with CHF and left ventricular ejection fraction of 33%, there was a statistically significant prevalence of TD in men aged ≤45 or ≥66 years, and worsening severity of CHF was associated with a stepwise decrease in levels of both total and free testosterone11
A meta-analysis of studies investigating exercise capacity in men with CHF showed that TRT improved 6-minute walk test, isometric walk test, and peak VO2 by 16.7%, 15.9%, and 22.7%, respectively12
Based on findings from investigative models, TRT may improve exercise capacity in men with CHF via a peripheral mechanism, such as increasing type I muscle fiber proliferation13
T2DM, a risk factor for atherosclerosis and CAD, is associated with significantly lower levels of total14 and free15 testosterone versus nondiabetics


The risk of developing T2DM significantly decreased with higher endogenous total testosterone levels, but no significant association was seen for bioavailable testosterone16
In clinical studies, TRT has improved levels of HbA1c (0.37–1.5%), homeostatic model of insulin resistance (HOMA-IR), and fasting plasma glucose (0.61–1.9 mmol/L) in hypogonadal men with diabetes15,17-21
The bidirectional relationship between T2DM and TD is complex and requires further study
A pilot study in three hypogonadal men showed that TRT altered the lipid composition of erythrocyte membranes, suggesting that TRT can influence erythrocyte flexibility and improve diabetic microvascular complications22
Total testosterone levels are inversely related to BMI, a risk factor for atherosclerosis


The Swedish MrOS study in 2416 men showed a significant decrease in BMI with increasing quartiles of total testosterone: 28.1 and 24.9 kg/m2 for the first and fourth quartile, respectively23
TRT has been shown to improve obesity, with significant reductions in BMI (–1.3 kg/m2 at 30 weeks)20 and fat mass (–2.19%)15
It is proposed that testosterone may reduce obesity through increased lipolysis and decreased fat accumulation in visceral adipose tissue1
Testosterone may exert protective effects against cardiovascular events such as atherosclerosis by suppressing the systemic inflammatory response and leukocyte activation in the vasculature


Evidence shows that testosterone levels are inversely correlated to carotid intima-media thickness,24,25 a marker for preclinical atherosclerosis
Data for the MoA of this anti-inflammatory effect are conflicting; in-vitro studies propose antagonism of the androgen26,27 and estrogen receptors28 in human umbilical vein endothelial cells, as well as androgen and estrogen receptor-independent mechanisms29
Testosterone levels are significantly negatively associated with QTc length, a risk factor for CAD and torsades de pointes,30,31 suggesting that testosterone has a role in regulating ventricular polarization


In 26 hypogonadal men, TRT normalized QTc length (average decrease 66 ms) in all subjects with prolonged QTc length32
Animal study results suggest that testosterone reduces the QTc length by increasing the activity of potassium channels and simultaneously slowing the activity of L-type calcium channels33

What is known
Despite an increasing incidence of hypogonadism in the USA,34 the relationship between testosterone levels and cardiovascular health is not fully understood. Low levels of testosterone are associated with comorbidities known to increase cardiovascular mortality, such as T2DM and obesity.23 In a meta-analysis of seven population-based studies, low levels of testosterone showed a trend towards an association with increased cardiovascular mortality.35 Although statistical significance was not attained, the study showed that a decrease of 2.1 standard deviations in total testosterone levels was associated with a 25% increase in cardiovascular mortality risk. Two further studies have analyzed the association between testosterone and cardiovascular mortality.36,37 Menke et al. showed that a reduction of testosterone levels from the 90th to the 10th percentile correlated with a significant increase in cardiovascular mortality.36 In agreement with Menke et al., Malkin et al. demonstrated that levels of bioavailable testosterone > 2.6 nmol/L were associated with improved survival from vascular mortality (death from atherosclerosis, heart failure, or cardiac arrest) in 930 men with CAD.37 The association between testosterone and cardiovascular diseases is well documented; however, the exact mechanisms behind this are currently unknown. Further investigation is required to fully elucidate the MoA of testosterone in the cardiovascular system and develop further treatment targets.
What this study adds
A comprehensive review of the clinical literature shows that patients with CAD,2,3 CHF,11 T2DM,14,15 and obesity23 have low testosterone levels. Furthermore, levels of testosterone in hypogonadal men were associated with the severity of CAD2,3 and CHF.11 TRT in hypogonadal men improves a number of cardiovascular health factors. In hypogonadal men with CAD, TRT improved exercise-induced 1-mm ST-segment depression,4,5 a measure of myocardial ischemia, and vasodilation and coronary artery blood flow.6 In patients with CHF, TRT significantly improved components of exercise capacity, a fundamental feature of CHF.12 Furthermore, TRT improved a number of risk factors for atherosclerosis, including T2DM,15,17-21 obesity,15,20 and QTc length.32 Overall, these findings suggest that testosterone plays an important role in the cardiovascular system and maintaining cardiovascular health.

The exact mechanisms of testosterone that influence the cardiovascular system are not yet fully elucidated. Conflicting evidence for possible underlying mechanisms are from experimental in-vitro, animal, and pilot studies, such as Angelova et al.22 This highlights how in-vitro studies play a key role in determining the positive effects of testosterone on the cardiovascular system. Despite the growing evidence for the important role of testosterone on the cardiovascular system, the Endocrine Society guidelines make no recommendations for screening of hypogonadism in patients with heart disease.38 Furthermore, using TRT in patients with heart disease to improve survival is not recommended. As such, longitudinal, placebo-controlled, randomized trials of TRT in hypogonadal men are warranted to understand the role of testosterone in cardiovascular diseases.
References
1. Mesbah Oskui P, French WJ, Herring MJ, et al. Testosterone and the cardiovascular system: a comprehensive review of the clinical literature. J Am Heart Assoc 2013;2(6):e000272.
2. Dobrzycki S, Serwatka W, Nadlewski S, et al. An assessment of correlations between endogenous sex hormone levels and the extensiveness of coronary heart disease and the ejection fraction of the left ventricle in males. J Med Invest 2003;50:162-169.
3. Rosano GM, Sheiban I, Massaro R, et al. Low testosterone levels are associated with coronary artery disease in male patients with angina. Int J Impot Res 2007;19(2):176-182.
4. English KM, Steeds RP, Jones TH, et al. Low-dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina: A randomized, double-blind, placebo-controlled study. Circulation 2000;102(16):1906-1911.
5. Rosano GM, Leonardo F, Pagnotta P, et al. Acute anti-ischemic effect of testosterone in men with coronary artery disease. Circulation 1999;99(13):1666-1670.
6. Webb CM, McNeill JG, Hayward CS, et al. Effects of testosterone on coronary vasomotor regulation in men with coronary heart disease. Circulation 1999;100(16):1690-1696.
7. Tep-areenan P, Kendall DA, Randall MD. Testosterone-induced vasorelaxation in the rat mesenteric arterial bed is mediated predominantly via potassium channels. Br J Pharmacol 2002;135(3):735-740.
8. English KM, Jones RD, Jones TH, et al. Testosterone acts as a coronary vasodilator by a calcium antagonistic action. J Endocrinol Invest 2002;25(5):455-458.
9. Miller VM, Mulvagh SL. Sex steroids and endothelial function: translating basic science to clinical practice. Trends Pharmacol Sci 2007;28(6):263-270.
10. Jones RD, Pugh PJ, Hall J, et al. Altered circulating hormone levels, endothelial function and vascular reactivity in the testicular feminised mouse. Eur J Endocrinol 2003;148(1):111-120.
11. Jankowska EA, Biel B, Majda J, et al. Anabolic deficiency in men with chronic heart failure: prevalence and detrimental impact on survival. Circulation 2006;114(17):1829-1837.
12. Toma M, McAlister FA, Coglianese EE, et al. Testosterone supplementation in heart failure: a meta-analysis. Circ Heart Fail 2012;5(3):315-321.
13. Czesla M, Mehlhorn G, Fritzsche D, et al. Cardiomyoplasty - improvement of muscle fibre type transformation by an anabolic steroid (metenolone). J Mol Cell Cardiol 1997;29(11):2989-2996.
14. Ding EL, Song Y, Malik VS, et al. Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2006;295(11):1288-1299.
15. Corona G, Monami M, Rastrelli G, et al. Type 2 diabetes mellitus and testosterone: a meta-analysis study. Int J Androl 2011;34(6 Pt 1):528-540.
16. Colangelo LA, Ouyang P, Liu K, et al. Association of endogenous sex hormones with diabetes and impaired fasting glucose in men: multi-ethnic study of atherosclerosis. Diabetes Care 2009;32(6):1049-1051.
17. Jones TH, Arver S, Behre HM, et al. Testosterone replacement in hypogonadal men with type 2 diabetes and/or metabolic syndrome (the TIMES2 study). Diabetes Care 2011;34(4):828-837.
18. Kapoor D, Goodwin E, Channer KS, et al. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2006;154(6):899-906.
19. Heufelder AE, Saad F, Bunck MC, et al. Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and improves glycemic control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone. J Androl 2009;30(6):726-733.
20. Kalinchenko SY, Tishova YA, Mskhalaya GJ, et al. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol (Oxf) 2010;73(5):602-612.
21. Malkin CJ, Jones TH, Channer KS. The effect of testosterone on insulin sensitivity in men with heart failure. Eur J Heart Fail 2007;9(1):44-50.
22. Angelova P, Momchilova A, Petkova D, et al. Testosterone replacement therapy improves erythrocyte membrane lipid composition in hypogonadal men. Aging Male 2012;15(3):173-179.
23. Ohlsson C, Barrett-Connor E, Bhasin S, et al. High serum testosterone is associated with reduced risk of cardiovascular events in elderly men. The MrOS (Osteoporotic Fractures in Men) study in Sweden. J Am Coll Cardiol 2011;58(16):1674-1681.
24. Fukui M, Kitagawa Y, Nakamura N, et al. Association between serum testosterone concentration and carotid atherosclerosis in men with type 2 diabetes. Diabetes Care 2003;26(6):1869-1873.
25. Vikan T, Johnsen SH, Schirmer H, et al. Endogenous testosterone and the prospective association with carotid atherosclerosis in men: the Tromso study. Eur J Epidemiol 2009;24(6):289-295.
26. Zhang X, Wang LY, Jiang TY, et al. Effects of testosterone and 17-beta-estradiol on TNF-alpha-induced E-selectin and VCAM-1 expression in endothelial cells. Analysis of the underlying receptor pathways. Life Sci 2002;71(1):15-29.
27. McCrohon JA, Jessup W, Handelsman DJ, et al. Androgen exposure increases human monocyte adhesion to vascular endothelium and endothelial cell expression of vascular cell adhesion molecule-1. Circulation 1999;99(17):2317-2322.
28. Mukherjee TK, Dinh H, Chaudhuri G, et al. Testosterone attenuates expression of vascular cell adhesion molecule-1 by conversion to estradiol by aromatase in endothelial cells: implications in atherosclerosis. Proc Natl Acad Sci U S A 2002;99(6):4055-4060.
29. Bourghardt J, Wilhelmson AS, Alexanderson C, et al. Androgen receptor-dependent and independent atheroprotection by testosterone in male mice. Endocrinology 2010;151(11):5428-5437.
30. Charbit B, Christin-Maitre S, Demolis JL, et al. Effects of testosterone on ventricular repolarization in hypogonadic men. Am J Cardiol 2009;103(6):887-890.
31. van Noord C, Dorr M, Sturkenboom MC, et al. The association of serum testosterone levels and ventricular repolarization. Eur J Epidemiol 2010;25(1):21-28.
32. Pecori Giraldi F, Toja PM, Filippini B, et al. Increased prevalence of prolonged QT interval in males with primary or secondary hypogonadism: a pilot study. Int J Androl 2010;33(1):e132-138.
33. Bai CX, Kurokawa J, Tamagawa M, et al. Nontranscriptional regulation of cardiac repolarization currents by testosterone. Circulation 2005;112(12):1701-1710.
34. Araujo AB, O'Donnell AB, Brambilla DJ, et al. Prevalence and incidence of androgen deficiency in middle-aged and older men: estimates from the Massachusetts Male Aging Study. J Clin Endocrinol Metab 2004;89(12):5920-5926.
35. Araujo AB, Dixon JM, Suarez EA, et al. Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011;96(10):3007-3019.
36. Menke A, Guallar E, Rohrmann S, et al. Sex steroid hormone concentrations and risk of death in US men. Am J Epidemiol 2010;171(5):583-592.
37. Malkin CJ, Pugh PJ, Morris PD, et al. Low serum testosterone and increased mortality in men with coronary heart disease. Heart 2010;96(22):1821-1825.
38. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006;91(6):1995-2010.

[marcus300]

19 December 2013

Testosterone replacement therapy can improve cardiovascular disease risk factors in patients with testosterone deficiency

Image: Bathroom ccales and a heartbeat stethoscope Androgen therapy in men with testosterone deficiency: can testosterone reduce the risk of cardiovascular disease. Saad F. Diabetes Metab Res Rev 2012; 28(Suppl 2): 52-59.

Many cardiovascular risk factors are known to contribute towards cardiovascular disease (CVD). Testosterone replacement therapy (TRT) is indicated for males with testosterone deficiency (TD; total blood testosterone

Whilst data relating to the use of TRT in improving cardiovascular health are limited, they remain relevant and require further investigation. To address this gap, a recent publication reviewed epidemiological/observational data supporting the relationship between TD and CVD factors.1 The potential role of TRT in reducing the risk of CVD was also discussed based on data from studies using TRT in males with TD.
Key Points


TRT in males with TD has consistently resulted in improvements in body composition, including reducing fat mass, a known risk factor for progression to CVD


A placebo-controlled study investigating the effects of testosterone on body composition, without controlled diet or exercise intervention, showed that testosterone reduced fat mass by 5.4 kg and increased lean mass by 4.2 kg, representing a moderate overall weight reduction of 1.2 kg2
In a 24-month, placebo-controlled study, treatment with testosterone undecanoate (TU) 1,000 mg/12 weeks, with no controlled diet or exercise intervention, reduced fat mass by 18.5% after 12 months, and this was maintained at 19.2% after 24 months3
After 12 months, the placebo-group was switched to treatment with TU 1,000 mg/12 weeks, which reduced fat mass by 17.5% after another 12 months3
Long-term studies have shown that testosterone has a vasodilatory effect that results in reductions in blood pressure, a major contributor to atherosclerosis


Treatment with TU was associated with reductions in systolic and diastolic blood pressure of 22 mmHg and 19 mmHg, respectively, in a ≥4-year observation group of 281 men at the Centre of Clinical Andrology at the University of Muenster1
Increasing evidence from studies suggests that TRT improves insulin sensitivity and lipid profiles, which may be closely associated with reductions in fat mass and increased muscle mass


Two double-blind, randomized studies by Aversa et al. have shown that TU 1,000 mg/12 weeks significantly reduced homeostasis model assessment (HOMA) index of insulin resistance at 12 months versus placebo (both p3,4
In a 52-week, randomized, single-blind study combining diet and exercise with or without testosterone treatment, TRT significantly reduced triglyceride levels and increased HDL cholesterol levels versus treatment without testosterone (both p5
TRT has demonstrated anti-coagulatory and anti-inflammatory effects that, combined, contribute to a reduction in carotid intima media thickness (CIMT), a clinically relevant measurement of atherosclerosis


Treatment with testosterone reduces levels of fibrinogen, a component of the coagulation cascade, and plasminogen activator inhibitor-1, an inhibitor of thrombolysis, which are of major importance in coronary disease1
The Moscow study, a large, 30-week, placebo-controlled trial in 184 men with metabolic syndrome and hypogonadism, demonstrated the anti-inflammatory properties of TU, which significantly decreased levels of tumor necrosis factor-α (TNF-α, p=0.03) and C-reactive protein (CRP, p6
Aversa et al. demonstrated a dose-dependent reduction in CIMT with TU 1,000 mg/12 weeks versus placebo (p3
TRT in males with TD may potentially decrease the risk of CVD; however, further investigation in controlled trials with large patient populations is required to confirm these findings

What is known
Findings from epidemiological and observational studies have suggested that individual CVD risk factors (BMI, abnormal lipid profiles, hypertension, insulin resistance, endothelial dysfunction, and the elevation of pro-inflammatory factors) are common in males with TD (Figure 1). Data from the European Male Aging Study showed that lowered levels of testosterone are associated with BMI, with reduced levels of testosterone in obese males (BMI ≥30 kg/m2).7 A study by Svartberg et al.8 in 1,548 males demonstrated that low levels of total testosterone are inversely associated with elevated systolic blood pressure. Kapoor et al.9 and Hak et al.10 showed that low levels of total testosterone are inversely associated with CRP levels and progression of aortic atherosclerosis, respectively. Furthermore, Nettleship et al.11 observed an inverse relationship between levels of testosterone and inflammatory markers in elderly males.

Low levels of testosterone have been associated with increased cardiovascular mortality in longitudinal studies. A meta-analysis, published in 2011, investigating all-cause (16,184 patients) and CVD mortality (11,831 patients) in community-based males observed that TD was associated with increased risk of all-cause and CVD mortality.12 Additionally, the EPIC-Norfolk study reported that patients with the lowest levels of testosterone had the shortest survival.13
What these studies add
Evidence from this 2012 review suggests that treatment with TRT in males with TD has the potential to improve all major cardiovascular risk factors.1 Data discussed within this review suggest that TRT can achieve moderate weight reductions,2 with long-term reductions in fat mass of approximately 18%.3 The consequent improvements in body composition provided by TRT may also contribute to the favorable improvements observed in insulin sensitivity and lipid profiles.




Data (as yet to be published) from the Centre of Clinical Andrology at the University of Muenster, suggest that long-term testosterone acts as a vasodilator, and reduces both diastolic and systolic blood pressure.1 Whilst these improvements may also be associated with weight loss as a result of TRT, testosterone is known to improve several factors of endothelial function, including an increase in endothelial nitric oxide synthase and a reduction in asymmetric dimethyl arginine. The potential for TRT to reduce anti-coagulatory and anti-inflammatory levels may contribute to a reduction in CIMT, a clinically important measurement in progression to atherosclerosis.

Early identification of TD in males and initiation of TRT may prevent progression of cardiovascular risk factors to CVD. The potential for testosterone to reduce CVD and mortality risk factors in males with TD (effectively ameliorating many of the CVD risk factors summarized in Figure 1) suggests that further investigation in long-term controlled trials with large patient populations should be pursued.


Effects of testosterone replacement therapy on cardiovascular risk factors commonly observed in males with testosterone deficiency Figure 1: Effects of testosterone replacement therapy on cardiovascular risk factors commonly observed in males with testosterone deficiency References
1. Saad F. Androgen therapy in men with testosterone deficiency: can testosterone reduce the risk of cardiovascular disease? Diabetes Metab Res Rev 2012;28 (Suppl 2):52-59.
2. Svartberg J, Agledahl I, Figenschau Y, et al. Testosterone treatment in elderly men with subnormal testosterone levels improves body composition and BMD in the hip. Int J Impot Res 2008;20(4):378-387.
3. Aversa A, Bruzziches R, Francomano D, et al. Effects of testosterone undecanoate on cardiovascular risk factors and atherosclerosis in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 24-month, randomized, double-blind, placebo-controlled study. J Sex Med 2010;7(10):3495-3503.
4. Aversa A, Bruzziches R, Francomano D, et al. Efficacy and safety of two different testosterone undecanoate formulations in hypogonadal men with metabolic syndrome. J Endocrinol Invest 2010;33(11):776-783.
5. Heufelder AE, Saad F, Bunck MC, et al. Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and improves glycemic control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone. J Androl 2009;30(6):726-733.
6. Kalinchenko SY, Tishova YA, Mskhalaya GJ, et al. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol (Oxf) 2010;73(5):602-612.
7. Wu FC, Tajar A, Pye SR, et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab 2008;93(7):2737-2745.
8. Svartberg J, von Muhlen D, Schirmer H, et al. Association of endogenous testosterone with blood pressure and left ventricular mass in men. The Tromso Study. Eur J Endocrinol 2004;150(1):65-71.
9. Kapoor D, Clarke S, Stanworth R, et al. The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2007;156(5):595-602.
10. Hak AE, Witteman JC, de Jong FH, et al. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam study. J Clin Endocrinol Metab 2002;87(8):3632-3639.
11. Nettleship JE, Pugh PJ, Channer KS, et al. Inverse relationship between serum levels of interleukin-1beta and testosterone in men with stable coronary artery disease. Horm Metab Res 2007;39(5):366-371.
12. Araujo AB, Dixon JM, Suarez EA, et al. Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011;96(10):3007-3019.
13. Khaw K, 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(23):2694-2701.

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[BG]

MD magazine this month had an article about this also...........

[davidtheman100]

19 December 2013

Testosterone replacement therapy can improve cardiovascular disease risk factors in patients with testosterone deficiency

Image: Bathroom ccales and a heartbeat stethoscope Androgen therapy in men with testosterone deficiency: can
testosterone reduce the risk of cardiovascular disease. Saad F. Diabetes Metab Res Rev 2012; 28(Suppl 2): 52-59.

Many cardiovascular risk factors are known to contribute towards cardiovascular disease (CVD). Testosterone replacement therapy (TRT) is indicated for males with testosterone deficiency (TD; total blood testosterone

Whilst data relating to the use of TRT in improving cardiovascular health are limited, they remain relevant and require further investigation. To address this gap, a recent publication reviewed epidemiological/observational data supporting the relationship between TD and CVD factors.1 The potential role of TRT in reducing the risk of CVD was also discussed based on data from studies using TRT in males with TD.
Key Points


TRT in males with TD has consistently resulted in improvements in body composition, including reducing fat mass, a known risk factor for progression to CVD


A placebo-controlled study investigating the effects of testosterone on body composition, without controlled diet or exercise intervention, showed that testosterone reduced fat mass by 5.4 kg and increased lean mass by 4.2 kg, representing a moderate overall weight reduction of 1.2 kg2
In a 24-month, placebo-controlled study, treatment with testosterone undecanoate (TU) 1,000 mg/12 weeks, with no controlled diet or exercise intervention, reduced fat mass by 18.5% after 12 months, and this was maintained at 19.2% after 24 months3
After 12 months, the placebo-group was switched to treatment with TU 1,000 mg/12 weeks, which reduced fat mass by 17.5% after another 12 months3
Long-term studies have shown that testosterone has a vasodilatory effect that results in reductions in blood pressure, a major contributor to atherosclerosis


Treatment with TU was associated with reductions in systolic and diastolic blood pressure of 22 mmHg and 19 mmHg, respectively, in a ≥4-year observation group of 281 men at the Centre of Clinical Andrology at the University of Muenster1
Increasing evidence from studies suggests that TRT improves insulin sensitivity and lipid profiles, which may be closely associated with reductions in fat mass and increased muscle mass


Two double-blind, randomized studies by Aversa et al. have shown that TU 1,000 mg/12 weeks significantly reduced homeostasis model assessment (HOMA) index of insulin resistance at 12 months versus placebo (both p3,4
In a 52-week, randomized, single-blind study combining diet and exercise with or without testosterone treatment, TRT significantly reduced triglyceride levels and increased HDL cholesterol levels versus treatment without testosterone (both p5
TRT has demonstrated anti-coagulatory and anti-inflammatory effects that, combined, contribute to a reduction in carotid intima media thickness (CIMT), a clinically relevant measurement of atherosclerosis


Treatment with testosterone reduces levels of fibrinogen, a component of the coagulation cascade, and plasminogen activator inhibitor-1, an inhibitor of thrombolysis, which are of major importance in coronary disease1
The Moscow study, a large, 30-week, placebo-controlled trial in 184 men with metabolic syndrome and hypogonadism, demonstrated the anti-inflammatory properties of TU, which significantly decreased levels of tumor necrosis factor-α (TNF-α, p=0.03) and C-reactive protein (CRP, p6
Aversa et al. demonstrated a dose-dependent reduction in CIMT with TU 1,000 mg/12 weeks versus placebo (p3
TRT in males with TD may potentially decrease the risk of CVD; however, further investigation in controlled trials with large patient populations is required to confirm these findings

What is known
Findings from epidemiological and observational studies have suggested that individual CVD risk factors (BMI, abnormal lipid profiles, hypertension, insulin resistance, endothelial dysfunction, and the elevation of pro-inflammatory factors) are common in males with TD (Figure 1). Data from the European Male Aging Study showed that lowered levels of testosterone are associated with BMI, with reduced levels of testosterone in obese males (BMI ≥30 kg/m2).7 A study by Svartberg et al.8 in 1,548 males demonstrated that low levels of total testosterone are inversely associated with elevated systolic blood pressure. Kapoor et al.9 and Hak et al.10 showed that low levels of total testosterone are inversely associated with CRP levels and progression of aortic atherosclerosis, respectively. Furthermore, Nettleship et al.11 observed an inverse relationship between levels of testosterone and inflammatory markers in elderly males.

Low levels of testosterone have been associated with increased cardiovascular mortality in longitudinal studies. A meta-analysis, published in 2011, investigating all-cause (16,184 patients) and CVD mortality (11,831 patients) in community-based males observed that TD was associated with increased risk of all-cause and CVD mortality.12 Additionally, the EPIC-Norfolk study reported that patients with the lowest levels of testosterone had the shortest survival.13
What these studies add
Evidence from this 2012 review suggests that treatment with TRT in males with TD has the potential to improve all major cardiovascular risk factors.1 Data discussed within this review suggest that TRT can achieve moderate weight reductions,2 with long-term reductions in fat mass of approximately 18%.3 The consequent improvements in body composition provided by TRT may also contribute to the favorable improvements observed in insulin sensitivity and lipid profiles.




Data (as yet to be published) from the Centre of Clinical Andrology at the University of Muenster, suggest that long-term testosterone acts as a vasodilator, and reduces both diastolic and systolic blood pressure.1 Whilst these improvements may also be associated with weight loss as a result of TRT, testosterone is known to improve several factors of endothelial function, including an increase in endothelial nitric oxide synthase and a reduction in asymmetric dimethyl arginine. The potential for TRT to reduce anti-coagulatory and anti-inflammatory levels may contribute to a reduction in CIMT, a clinically important measurement in progression to atherosclerosis.

Early identification of TD in males and initiation of TRT may prevent progression of cardiovascular risk factors to CVD. The potential for testosterone to reduce CVD and mortality risk factors in males with TD (effectively ameliorating many of the CVD risk factors summarized in Figure 1) suggests that further investigation in long-term controlled trials with large patient populations should be pursued.


Effects of testosterone replacement therapy on cardiovascular risk factors commonly observed in males with testosterone deficiency Figure 1: Effects of testosterone replacement therapy on cardiovascular risk factors commonly observed in males with testosterone deficiency References
1. Saad F. Androgen therapy in men with testosterone deficiency: can testosterone reduce the risk of cardiovascular disease? Diabetes Metab Res Rev 2012;28 (Suppl 2):52-59.
2. Svartberg J, Agledahl I, Figenschau Y, et al. Testosterone treatment in elderly men with subnormal testosterone levels improves body composition and BMD in the hip. Int J Impot Res 2008;20(4):378-387.
3. Aversa A, Bruzziches R, Francomano D, et al. Effects of testosterone undecanoate on cardiovascular risk factors and atherosclerosis in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 24-month, randomized, double-blind, placebo-controlled study. J Sex Med 2010;7(10):3495-3503.
4. Aversa A, Bruzziches R, Francomano D, et al. Efficacy and safety of two different testosterone undecanoate formulations in hypogonadal men with metabolic syndrome. J Endocrinol Invest 2010;33(11):776-783.
5. Heufelder AE, Saad F, Bunck MC, et al. Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and improves glycemic control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone. J Androl 2009;30(6):726-733.
6. Kalinchenko SY, Tishova YA, Mskhalaya GJ, et al. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol (Oxf) 2010;73(5):602-612.
7. Wu FC, Tajar A, Pye SR, et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab 2008;93(7):2737-2745.
8. Svartberg J, von Muhlen D, Schirmer H, et al. Association of endogenous testosterone with blood pressure and left ventricular mass in men. The Tromso Study. Eur J Endocrinol 2004;150(1):65-71.
9. Kapoor D, Clarke S, Stanworth R, et al. The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2007;156(5):595-602.
10. Hak AE, Witteman JC, de Jong FH, et al. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam study. J Clin Endocrinol Metab 2002;87(8):3632-3639.
11. Nettleship JE, Pugh PJ, Channer KS, et al. Inverse relationship between serum levels of interleukin-1beta and testosterone in men with stable coronary artery disease. Horm Metab Res 2007;39(5):366-371.
12. Araujo AB, Dixon JM, Suarez EA, et al. Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011;96(10):3007-3019.
13. Khaw K, 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(23):2694-2701.

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Just curious, how can you debunk people involved in the study, and that experienced those heart problems? There are lawsuits against androgel and how they've lead to sudden cardiac problems. If you watch ANY TV AT ALL you would have seen those.

It really just seems like denial. None of you will deny that it will make your cholesterol worse, or that it will increase your blood pressure, yet you will NEVER admit that you can have cardiac risks associated with the stuff. High cholesterol, and high blood pressure DIRECTLY CORRELATE to heart disease and enlargement.

People are still finding new things out about things being used for over 200 years. So a new study on something that has been around for 70 years will be debunked in no time. They will be finding out new things in no time to prove that wrong. I've heard people on TRT for many years tell me that they're basically being used as guinea pigs because there isn't enough research done on the topic. Doctors are reluctant to prescribe it to people in the first place.

Just because you're an avid AAS user DOES NOT mean TRT has no risks associated with it. I can't BEGIN to say how dumb that it sounds. Every lifetime treatment has it's risks, and a good amount of them. By basically saying that the only risks of TRT is increased muscle mass and insulin sensitivity is a telltale sign of denial.

[kelkel]

Just curious, how can you debunk people involved in the study, and that experienced those heart problems? There are lawsuits against androgel and how they've lead to sudden cardiac problems. If you watch ANY TV AT ALL you would have seen those.
True, but the root cause is poor medical care, not simply testosterone. Remember, Lawyers will sue anybody for anything.

It really just seems like denial. None of you will deny that it will make your cholesterol worse, or that it will increase your blood pressure, yet you will NEVER admit that you can have cardiac risks associated with the stuff. High cholesterol, and high blood pressure DIRECTLY CORRELATE to heart disease and enlargement.

I'll deny it. It can lower HDL slightly but the overall benefits far outweigh that. Test does not directly cause high chol and a proper protocol will not cause high BP. Can't blame everything on test: Read this...

The Testosterone Controversy - Life Extension



People are still finding new things out about things being used for over 200 years. So a new study on something that has been around for 70 years will be debunked in no time. They will be finding out new things in no time to prove that wrong. I've heard people on TRT for many years tell me that they're basically being used as guinea pigs because there isn't enough research done on the topic. Doctors are reluctant to prescribe it to people in the first place.
Properly run studies are not debunked. Flawed studies are, such as the original one you suggested. It was debunked by the top doc's in TRT as well as virtually all medical organizations. Yes, it was that flawed. Your friends that feel like guinea pigs are probably treated by doctors who don't know hormones. Unfortunately that's very prevalent but will change over time. Finding the right doc is key.

Don't forget, our generation has the ability to live a much healthier and longer life due to testosterone replacement. Our parents generation did not have this ability.

Just because you're an avid AAS user DOES NOT mean TRT has no risks associated with it. I can't BEGIN to say how dumb that it sounds. Every lifetime treatment has it's risks, and a good amount of them. By basically saying that the only risks of TRT is increased muscle mass and insulin sensitivity is a telltale sign of denial.

Agreed. Always a risk with any medication taken. It's why self-education and a good relationship with a knowledgeable doctor is paramount for a healthy, active lifestyle.

[Metalject]

Just curious, how can you debunk people involved in the study, and that experienced those heart problems? There are lawsuits against androgel and how they've lead to sudden cardiac problems. If you watch ANY TV AT ALL you would have seen those.

It really just seems like denial. None of you will deny that it will make your cholesterol worse, or that it will increase your blood pressure, yet you will NEVER admit that you can have cardiac risks associated with the stuff. High cholesterol, and high blood pressure DIRECTLY CORRELATE to heart disease and enlargement.

People are still finding new things out about things being used for over 200 years. So a new study on something that has been around for 70 years will be debunked in no time. They will be finding out new things in no time to prove that wrong. I've heard people on TRT for many years tell me that they're basically being used as guinea pigs because there isn't enough research done on the topic. Doctors are reluctant to prescribe it to people in the first place.

Just because you're an avid AAS user DOES NOT mean TRT has no risks associated with it. I can't BEGIN to say how dumb that it sounds. Every lifetime treatment has it's risks, and a good amount of them. By basically saying that the only risks of TRT is increased muscle mass and insulin sensitivity is a telltale sign of denial.

I think most sane people would agree, with anything you put into your body, natural or otherwise, there is a potential for risks. The argument, at least the important one, is are the risks manageable and do the potential benefits outweigh the risks? The two studies that started all the recent law suits, the studies imply that taking testosterone increases cardiovascular incidence - it makes no effort to discuss if risks can be reduced by managed care.

[Honkey_Kong]

That article really didn't make it clear if it was the low testosterone that caused the increase in heart attacks or if it were the raised estrogen levels.

[davidtheman100]

I think most sane people would agree, with anything you put into your body, natural or otherwise, there is a potential for risks. The argument, at least the important one, is are the risks manageable and do the potential benefits outweigh the risks? The two studies that started all the recent law suits, the studies imply that taking testosterone increases cardiovascular incidence - it makes no effort to discuss if risks can be reduced by managed care.

I don't think the studies were needed to start the law suits. They have testimonials who experienced the problems first hand. There are no more questions as to whether it's 100% true or not because it HAPPENED!

These people were evaluated thoroughly by doctors and experts in their field. It was not poor managed care that caused the problem. The article had the decency to not point out the obvious and say "They were looked at by a professional in the field while being given TRT."

Again, here is the denial. You're saying that "Yes" there IS risks associated with it, then you're pointing to something else that's already in-check as if it's causing the problem and it's not the product they're being given is the problem. They were 100% under medical supervision and still ran into problems. It is not even close to 100% safe.

Can it be beneficial? Yes it can, ESPECIALLY in the short term. Long term has NOT been studied or tested thoroughly enough to see whether it is good or bad. Hence why people feel like they're being a guinea pig.

I'd just like to say for the record that i have NEVER met someone over the age of 61 on TRT. Just me, personally.

[lovbyts]

We have member in their 60s and 70s on trt. You are looking very hard.

[thisAngelBites]

These people were evaluated thoroughly by doctors and experts in their field. It was not poor managed care that caused the problem. The article had the decency to not point out the obvious and say "They were looked at by a professional in the field while being given TRT."

Again, here is the denial. You're saying that "Yes" there IS risks associated with it, then you're pointing to something else that's already in-check as if it's causing the problem and it's not the product they're being given is the problem. They were 100% under medical supervision and still ran into problems. It is not even close to 100% safe.

Medical errors are like the third or fourth cause of death in the US, so I wouldn't put too much stock in patients that were 100% medically supervised. Physicians are just people and are subject to all the vagaries thereof, such as not being as well educated as they could be, practicing in areas where they are not up to date and not doing the highest quality continuing education etc. And some of those people design medical studies. You really have to look at the individual studies and their methodologies in order to draw conclusions about its validity (or find someone who knows how to read them and can sum them up for you). Just going by the fact that doctors were involved is a very blunt tool.

[kelkel]

I don't think the studies were needed to start the law suits. They have testimonials who experienced the problems first hand. There are no more questions as to whether it's 100% true or not because it HAPPENED!

These people were evaluated thoroughly by doctors and experts in their field. It was not poor managed care that caused the problem. The article had the decency to not point out the obvious and say "They were looked at by a professional in the field while being given TRT."

Again, here is the denial. You're saying that "Yes" there IS risks associated with it, then you're pointing to something else that's already in-check as if it's causing the problem and it's not the product they're being given is the problem. They were 100% under medical supervision and still ran into problems. It is not even close to 100% safe.

Can it be beneficial? Yes it can, ESPECIALLY in the short term. Long term has NOT been studied or tested thoroughly enough to see whether it is good or bad. Hence why people feel like they're being a guinea pig.

I'd just like to say for the record that i have NEVER met someone over the age of 61 on TRT. Just me, personally.

Did you even read the study? Or the rebuttal by virtually the entire medical community?
Remember, when your time comes for TRT and you're suffering from all the symptoms, be sure to say "no thanks" it's not safe and just live with it.

Question for you. Say you develop a pituitary tumor or another issue that shuts down your testosterone . Will you refuse treatment? Or will you accept it under competent medical care?

[hawk14dl]

My cholesterol, blood pressure, and everything else has improved on trt.

[davidtheman100]

Did you even read the study? Or the rebuttal by virtually the entire medical community?
Remember, when your time comes for TRT and you're suffering from all the symptoms, be sure to say "no thanks" it's not safe and just live with it.

Question for you. Say you develop a pituitary tumor or another issue that shuts down your testosterone. Will you refuse treatment? Or will you accept it under competent medical care?

I would accept it. Because i feel that low T is worse than having medically administered test. Even if i wasn't right about that, i would rather not feel shitty tired, and unable to build muscle all of the time. I would just know that there are some big risks involved. You're putting me in a situation where i kind of have to say yes though, so i don't know your point.

[davidtheman100]

Medical errors are like the third or fourth cause of death in the US, so I wouldn't put too much stock in patients that were 100% medically supervised. Physicians are just people and are subject to all the vagaries thereof, such as not being as well educated as they could be, practicing in areas where they are not up to date and not doing the highest quality continuing education etc. And some of those people design medical studies. You really have to look at the individual studies and their methodologies in order to draw conclusions about its validity (or find someone who knows how to read them and can sum them up for you). Just going by the fact that doctors were involved is
a very blunt tool.

So then on top of the fact that the treatment itself poses risks, you also have to deal with the fact that you're dealing with doctors that account for the 3rd or 4th most deaths in American people. Proving my point further

[kelkel]

I would accept it. Because i feel that low T is worse than having medically administered test. Even if i wasn't right about that, i would rather not feel shitty tired, and unable to build muscle all of the time. I would just know that there are some big risks involved. You're putting me in a situation where i kind of have to say yes though, so i don't know your point.

Not really putting you in that situation. Aging will do that by itself. I'm glad that you would choose it though. It's been a life saver for many of us.
Interesting conversation Dave.

[Metalject]

I don't think the studies were needed to start the law suits. They have testimonials who experienced the problems first hand. There are no more questions as to whether it's 100% true or not because it HAPPENED!

These people were evaluated thoroughly by doctors and experts in their field. It was not poor managed care that caused the problem. The article had the decency to not point out the obvious and say "They were looked at by a professional in the field while being given TRT."

Again, here is the denial. You're saying that "Yes" there IS risks associated with it, then you're pointing to something else that's already in-check as if it's causing the problem and it's not the product they're being given is the problem. They were 100% under medical supervision and still ran into problems. It is not even close to 100% safe.

Can it be beneficial? Yes it can, ESPECIALLY in the short term. Long term has NOT been studied or tested thoroughly enough to see whether it is good or bad. Hence why people feel like they're being a guinea pig.

I'd just like to say for the record that i have NEVER met someone over the age of 61 on TRT. Just me, personally.

The testimonies of those individuals come from the men in the aforementioned studies. That's what started the recent (past year) argument, the two studies that came out. However, as kelkel said, the studies have been shot down by a large portion of the medical community, even the FDA (who almost never supports testosterone ) stated the studies presented flawed data. One of the biggest things that was flawed, the men who had some type of cardiovascular incident, most had already had a previous cardiovascular incident.

The above studies are akin to this IMO: I'm 300lbs, obese and I eat crap every day. I then have a heart attack, no surprise. After my recovery I begin low testosterone treatment - nothing else in my life changes, I still eat like crap. I then, now using testosterone, have another heart attack. Would you say the testosterone caused my heart attack? Would I have had the heart attack anyway? I do have a history of heart attacks...did the testosterone increase the risk? All of these things have to be considered but often are not.

Further, saying someone is under medical supervision because they were prescribed isn't medical supervision if there's no monitoring of blood work, which is exactly the case that started these law suites. Again, one of the reasons even the FDA frowned on the studies.

Lastly, risk or no risk, no one is making these men take testosterone - this isn't the former Soviet Union and we are responsible for ourselves. Sure, we can argue that people should be able to trust their doctor, good argument but the problem with it is it's not the argument. People should have the right to undertake risk and poor information, biased information or spin shouldn't be part of the decision making process. And you can say spin comes from both sides, and you'd be right, it does. People often see what they want to see. As for myself, if TRT ends up killing me and I'm dead wrong about testosterone, I was still free to make my own choice. And hopefully the years I had left, although cut short, were better than they would have been without. IMO, no sane individual can argue that testosterone doesn't improve ones life, which is the foundation of the argument by the opposing crowd.

[lovbyts]

Its like any other lawsuit also, who are you going to go after or sue, the individual with limited funds or corporation with deep pockets? No matter what they say there are a lot of ambulance chasers out there.

[Narkissos]

You really can't win though, can you? For TRT the risks also include you being more prone to heart attacks as well.

Indeed.

*sigh*

*shoots up*

[5x10]

I asked a cardiologist what he thought about trts effects on the heart
He said the data was inconclusive either way(good or bad)

[Times Roman]

Study Links Sex Hormone Levels in the Blood to Risk of Sudden Cardiac Arrest

Thanks Angel, read and bookmarked.

Now, the million dollar question. The article indicates a correlation, but is LowT also causative?

In other words, after the fact analysis indicated for those who did have the heart attack, LowT was found. BUT, and this is a big BUT, does improving one's T profile reduce the risk? Or is there something else going on and low T is simply a marker?

[thisAngelBites]

Thanks Angel, read and bookmarked.

Now, the million dollar question. The article indicates a correlation, but is LowT also causative?

In other words, after the fact analysis indicated for those who did have the heart attack, LowT was found. BUT, and this is a big BUT, does improving one's T profile reduce the risk? Or is there something else going on and low T is simply a marker?

I don't think anyone knows. I posted it because there was a spate of articles in the medical news saying TRT was correlated with increased CV events, then this one came along that basically says low T is correlated with increased CV events. It might be a surrogate, and perhaps something like hematocrit is the culprit, but any researcher in this area should be watching such likely relationships.

In the end, I enjoy conflicting medical studies. I mean it would be great to have all these things untangled for people's benefit, but since they are not, and I happen to be quite interested in epistemology of science (especially medicine), this sort of thing fuels my intellectual pursuits.

[michael30]

David i agree yes there are some risks involved. More so if trt is given and the person has a sedentary lifestyle and bad eating habits. But honestly if trt was that bad dont you think ours and many other forums members would be dropping like flies?

[davidtheman100]

David i agree yes there are some risks involved. More so if trt is given and the person has a sedentary lifestyle and bad eating habits. But honestly if trt was that bad dont you think ours and many other forums members would be dropping like flies?

I don't think it's THAT BAD to the point where people would be dropping like flies lol... Or else it would never be prescribed in the first place.. But yet, it's bad enough that there have been lawsuits against androgen distributors because of the heart problems associated with trt, and the gel is only maybe a tenth as potent as pinning itself. As i've already said, i'd rather be on TRT then have low T though, so i'm not against it.

I'd say the risk factors are also associated with diet and exercise frequency, as well as the reason why their body is producing low amounts in the first place. The thing that would scare me the most, is the lack of study and research associated with this life-therapy treatment. I would want to be damn sure of what's going to happen to me, before i start pinning forever. However, you can't always get what you want. I'd still say it was in it's beginning stages, and that means there is alot of trial and error to be made, regardless of whether people want to believe it or not. Will it be at the cost of some of TRT patients longevity of life? I'd say so, just like any other treatment that hasn't been around for more than 60-70 yrs. To what degree? I don't know.

[lovbyts]

I don't think anyone knows. I posted it because there was a spate of articles in the medical news saying TRT was correlated with increased CV events, then this one came along that basically says low T is correlated with increased CV events. It might be a surrogate, and perhaps something like hematocrit is the culprit, but any researcher in this area should be watching such likely relationships.

In the end, I enjoy conflicting medical studies. I mean it would be great to have all these things untangled for people's benefit, but since they are not, and I happen to be quite interested in epistemology of science (especially medicine), this sort of thing fuels my intellectual pursuits.

Then you should enjoy this since it's 1000x more conflicting than TRT
After 27 Years: No Deaths from Vitamins, 3 Million from Prescription Drugs

[Metalject]

The big one for me is NSAID's, over 15,000 deaths per year each and every year due to NSAID's yet no one is calling for more research or to have these drugs labeled as prescription drugs. It would seem more law suites would be warranted here as compared to testosterone , although I wouldn't support either. Forming a basis of an opinion on how many law suits have been filled is a basis that rest on shaky ground.

And the idea that we don't know the long-term affects of testosterone, that there's no data, this kind of thinking and statements have always irritated me. For some reason we've held a blind eye and have started to pretend it's new.

Facts we know:

Synthetic Testosterone first came available in 1935 and was available commercially for sale in the form of Testosterone Propionate by Schering under the Testoviron brand name. Did Schering discontinue its research at this point? Far from it and there have been numerous studies and bodies of research since that time, not only as it pertains to testosterone but to many of the anabolic steroids that soon followed. Granted, many of these studies have been done outside the U.S., which often deems them irrelevant to those in the U.S. who proprot to be the emperors of synthetic rule. But this doesn't mean quality information isn't out there.

There have also been solid studies in the U.S. How the 1999 NEJM study goes so unnoticed boggles the mind, and that study showed suprapysiological doses of testosterone three times higher than the average high end TRT dose.

The big fact we know, the hundreds of thousands of men who have used testosterone, more so heavily than not over the course of the last nearly 100 years, why are they not all dying at younger ages or at least horrific deaths? Sure, we can point to some who have but we can point to that in any category of people steroid use or not. There needs to be significant numbers to warrant true concern but the only significant number we have is the same 100's of thousands of men living normal lives with their families and dying of old age.

And what is this risk people are so concerned with? Those who are concerned have decided it's up to them to decide how and who will be able to use testosterone. How about let these men exercise their right they hold under liberty to make this choice for themselves? In doing so, even if they spontaneously combust they are not hurting you. Decisions should be made by men and their families, not other men who govern themselves over such men in draped cloak of self-righteous superiority with a trail of minion butt kissers who echo their words. But that seems to be the society we live in today as it touches not only TRT but so many aspects of our lives. We give more and more responsibility to others, our governing bodies and in turn we give them our freedom of choice.