Volume 4, Issue 5
February 3, 2011
Does testosterone replacement
increase your heart-attack risk?
For years, I’ve told my patients and my readers that they probably need bio-identical testosterone therapy. Then one of our Reno hospitals put out a newsletter with this headline: “The higher the level of testosterone, the more likely you are to have a heart attack.” You can imagine the trouble this caused.
The man who brought it to me said, “Hey Doc, what’s going on? You put me on testosterone, and now I learn about this.” Of course, I knew something was wrong. After all, there have been so many studies over the years that have shown the exact opposite — that testosterone protects against heart disease. So I had to check out this new information.
The newsletter article was convincing. It quoted a new study showing that men with the highest levels of testosterone had a higher risk of developing heart disease than those with the lowest levels. And it went on to warn men that replacing their low levels of testosterone might cause them to have a heart attack. I was amazed. Was a landmark study going to blow the lid off everything that had been previously assumed about testosterone? Or was it a very poorly conducted study? As it turned out, the answer was neither.
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The newsletter did not reference the journal, title of the article, or the author. That was my first inkling that something was amiss. But there were some good clues. It said the study was new, and that the research came from Great Britain. Since the newsletter was a November issue, I started looking for articles released in the previous month. It didn't take long for me to find an article that matched the description.
The New England Journal of Medicine published the following in July of 2010: “Adverse events associated with testosterone replacement.” This study looked at a group of 209 men, 65 years old or older, with low testosterone levels. All of these men were at an increased risk of developing heart disease because they were afflicted with hypertension, diabetes, hyperlipidemia, and/or obesity. For six months, some of them applied a cream to their skin containing testosterone, and some a placebo cream. “During the course of the study, the testosterone group had higher rates of cardiac, respiratory, and dermatologic (adverse) events than did the placebo group.” Now on the face this is not good news for testosterone lovers like me. But there was a big problem with this study.
The relative risk of a cardiovascular-related adverse event remained constant throughout the six-month treatment period. In other words, the problems started right from the very beginning of the study, and they did not increase as the study went along. This strongly indicates that the increased incidence of events was not due to the testosterone. Testosterone just doesn’t work that fast. It takes three to six months for testosterone cream to have its effects. And since the sample size was small, it’s quite possible (even likely) that the researchers’ accidently assigned more men who were likely to have cardiovascular problems to the testosterone group than to the placebo group.
I’m betting this study was the one the hospital newsletter was writing about. A marketing writer would not likely have the ability to read between the lines in the same way that a medical professional can. So here are some learning lessons from this little diversion.
When you read something that goes against all the medical evidence, take it with a big grain of salt. If it sounds wrong, pass it by your doctor and ask him or her to check it out for you. A good doctor loves this. It’s one of the major ways we learn. Two, be especially wary of articles that do not contain references. That's why I always include them.
Finally, men, don’t be afraid of testosterone replacement therapy using bio-identical hormones. It’s far more likely to save your life than harm it.
Finding your Real Cures,
Frank Shallenberger, MD
Copyright 2011 Soundview Publishing, LLC
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