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Health & Medicine for Senior Citizens

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

By 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 testosterone.

 

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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 years.

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 problems

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 (JCEM).

"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. In its testosterone therapy clinical practice guidelines, The Endocrine Society recommends treating only men who have unequivocally low testosterone levels and consistent symptoms.

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 treatment."

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 affected.

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 cheating."

Test subjects with higher testosterone levels lied less

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. Weber.

"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 business

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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