Testosterone Therapy Lowers Cardiovascular Risk, or
Maybe Not, But It Makes Men Honest
New JAMA study finding testosterone therapy increases
cardiovascular risk has lots of other research to compete with - check
out these three
Tucker Sutherland, editor, SeniorJournal.com
Nov. 6, 2013 – Before older men make any decisions
about testosterone therapy based on the study released today in JAMA,
finding it may increase cardiovascular risk, they need to know about a
few other recent studies. One released just last month says therapy may
actually reduce this risk, while one in September says if you have low
testosterone you have greater risk of heart problems. Or, there is one
from last October that says men become more truthful after receiving
The JAMA study published on November 6 said that
among a group of older men who underwent coronary angiography and had a
low serum testosterone level, the use of testosterone therapy was
associated with increased risk of death, heart attack, or ischemic
stroke. (see link in box)
But, take a look at these three studies below.
Testosterone therapy may
reduce risk of cardiovascular disease
Just last month research from Boston University
School of Medicine (BUSM) suggested that testosterone treatment in
hypogonadal (testosterone deficient) men restores normal lipid profiles
and may reduce the risk of cardiovascular disease. These finding
appeared online in the International Journal of Clinical Practice.
Metabolic syndrome (MetS) is associated with
increased risk for cardiovascular disease and diabetes mellitus. There
is a strong association between MetS and testosterone deficiency.
Hypogonadal men are more likely to suffer from
metabolic syndrome characterized by dyslipidemia, insulin resistance,
diabetes and hypertension. Additionally, obese and overweight men also
may exhibit testosterone deficiency.
In this observational study, BUSM researchers
investigated the effects of testosterone treatment in 255 hypogonadal
men between the ages of 33-69 and followed them for a period of five
They found that men treated with testosterone
therapy experienced a gradual reduction of their total cholesterol, low
density lipoprotein cholesterol (LDL/bad cholesterol), triglycerides and
increased high density lipoprotein (HDL/(good cholesterol).
"In addition to improving their cholesterol levels,
we found that the testosterone treatment resulted in marked reductions
in systolic and diastolic blood pressure as well, suggesting
amelioration of hypertension," explained lead author Abdulmaged M.
Traish, MBA, PhD, professor of biochemistry and urology as well as
Research Director of the Institute of Sexual Medicine at BUSM.
"These data are congruent with our previous work in
which we reported that long-term testosterone resulted in a gradual
decline in weight and waist circumference and strongly suggests that
testosterone therapy in hypogonadal men may prove useful in reducing the
risk of cardiometabolic diseases," he added.
Having low testosterone linked to heart
The study released in September found men who have
low testosterone levels may have a slightly elevated risk of developing
or dying from heart disease. It was accepted for publication in The
Endocrine Society's Journal of Clinical Endocrinology & Metabolism
"When we reviewed the existing research into
testosterone and cardiovascular disease, a growing body of evidence
suggested a modest connection between the two. A specific pathogenesis
did not come forward, but perhaps less frequently investigated events
may play a role, such as thrombosis where a blood clot develops in the
circulatory system or arrhythmia, where there is a problem with the
heart beat or rate," said the study's lead author, Johannes Ruige, MD,
PhD, of Ghent University Hospital in Belgium. "Based on current
findings, though, we cannot rule out that low testosterone and heart
disease both result from poor overall health."
Treating low testosterone with replacement therapy
did not have any beneficial effect on cardiovascular health, Ruige said.
Although the number of older and middle-aged men
who are being prescribed testosterone replacement therapy is rising
rapidly, there is debate about whether the practice is too widespread.
testosterone therapy clinical
practice guidelines, The Endocrine Society recommends
treating only men who have unequivocally low testosterone levels and
The clinical review examined findings from studies
on cardiovascular disease and testosterone published between 1970 and
2013. Although the studies suggested some sort of relationship, existing
research found little evidence of a connection between low testosterone
and artherosclerosis, the hardening and narrowing of arteries that can
cause heart attacks and strokes. The reviewed studies also found no
relationship between testosterone levels and heart attacks.
Many of the studies had cross-sectional designs
that do not provide information about causality, but the review also
looked at 19 prospective observational studies that can provide
additional information about whether one condition causes another.
Because these studies did not completely rule out some potential
preceding causes of both low testosterone and cardiovascular disease,
additional research is needed to confirm the relationship between the
two conditions, Ruige said.
"Gaps still remain in our understanding of low
testosterone and cardiovascular disease," he said. "Ultimately, the goal
is to more accurately assess the impact testosterone substitution
therapy may have on the heart health of men who qualify for the
Testosterone increases honesty
Testosterone is considered the male hormone,
standing for aggression and posturing. Researchers around Prof. Dr.
Armin Falk, an economist from the University of Bonn, have now been able
to demonstrate that this sex hormone surprisingly also fosters social
behavior. In play situations, subjects who had received testosterone
clearly lied less frequently than individuals who had only received a
placebo. The results of this study released in October of 2012 were
published in the Public Library of Science's international online
journal "PLoS ONE."
The hormone testosterone stands for typically male
attributes – it fosters the forming of the sexual characteristics,
increases libido and muscle building. Women also have this sex hormone,
but to a much lesser extent. "Testosterone has always been said to
promote aggressive and risky behavior and posturing," reports Prof. Dr.
Bernd Weber, a neuro-scientist from the Center for Economics and
Neuroscience (CENS) at the University of Bonn. More recent studies
indicate, however, that this sex hormone also fosters social behavior.
Cause-and-effect issues remains unresolved
"The disadvantage of many studies is, however, that
they only correlate their subjects' testosterone level with their
behavior," explains lead author Dr. Matthias Wibral, adding that this
approach only reflects statistical links while not providing any
insights into the causes for the behavior.
"For testosterone does not only influence behavior;
behavior, in turn, also influences hormone levels." Consequently, the
CENS scientists were looking for an experimental approach that would
also allow deducing cause and effect.
Bonn researchers using new approach
The scientists recruited a total of 91 healthy men
for a behavioral experiment. Out of this group of subjects, 46 were
treated with testosterone by applying it to the skin in gel form. On the
following day, endocrinologists from the Bonn University Hospitals
checked whether the blood testosterone levels were indeed higher in
these subjects than in the placebo group.
The other 45 test subjects only received a placebo
gel. "Neither the subjects themselves nor the scientists performing the
study knew who had received testosterone and who hadn't," reports Dr.
Wibral. This was done to prevent behaviors from potentially being
Games of dice with cheating option
This was followed by the behavioral experiments.
The test subjects played a simple game of dice in separate booths. The
higher their scores, the higher the amounts of money they received as a
reward. "These experiments were designed such that the test subjects
were able to lie," reports Prof. Weber. "Due to the separate booths,
nobody knew whether they were entering their real scores into the
computer, or higher ones in order to get more money."
However, the scientists were able to determine
later whether the various test subjects had cheated or not.
"Statistically, the probability for all numbers on the dice to occur is
identical," explains the neuroscientist. "So, if there are outliers in
the higher numbers, this is a clear indication that subjects have been
Test subjects with higher testosterone levels
The researchers compared the results from the
testosterone group to those from the control group. "This showed that
the test subjects with the higher testosterone levels had clearly lied
less frequently than untreated test subjects," reports the economist
Prof. Dr. Armin Falk, who is one of the CENS co-directors with Prof.
"This result clearly contradicts the
one-dimensional approach that testosterone results in anti-social
behavior." He added that it is likely that the hormone increases pride
and the need to develop a positive self-image. "Against this background,
a few euros are obviously not a sufficient incentive to jeopardize one's
feeling of self-worth," Prof. Falk reckons.
Lies are widespread in personal life and
Great taboos are attached to the phenomenon of
lying. The Christian 8th Commandment, e.g., forbids "bearing false
witness." Prof. Falk says, "However, lies play a great part both in the
business world as well as in personal life." He adds that people
frequently do not just lie to their own advantage, but also in order to
protect or benefit others. This type of behavior and its economic
effects had been studied often. "However, there are very few studies on
the biological causes of lying," the Bonn economist explains. "In this
regard, this study has allowed us to make a big step forward."
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