Men with low blood testosterone levels are at increased risk for heart attacks (1), even though testosterone pills lower blood levels of the good HDL cholesterol and increase a man's chances of getting a heart attack. Men with the highest testosterone levels have the lowest blood insulin levels which prevents heart attacks (2). Insulin is necessary to keep blood sugar levels from rising too high, but it also can increase your chances of getting a heart attack by causing arteries to constrict, and making you fat by causing hunger and forcing your liver to make extra fat from the extra calories that you consume.
Testosterone injections can make older men with low blood levels of testosterone more interested in making love (1,2,3). The only reported significant side effect is an increase in the concentration of red blood cells that could cause clots. As men age from 50 to 70, their testosterone levels drop more than 40%, causing them to become fatter, and less sexual, muscular and assertive, and have smaller, weaker bones (4,8). Two major theoretical concerns about prescribing testosterone to older men are that they may cause a heart attack or spread an existing prostate cancer. However, only testosterone pills have been shown to lower blood levels of the good HDL cholesterol and cause heart attacks. Testosterone injections and skin patches do not (5,6,9).
Studies from Chicago Medical School (7) showed that men 60 to 75 years of age who take very low doses of the male hormone, testosterone (25 to 50 mg) weekly for two years, have lower blood cholesterol levels, less body fat and greater muscle strength. Their prostates did not enlarge and their PSA blood test did not rise. More research is needed, but older men who take testosterone, should use gel, injections or patches, rather than pills, and have their prostates checked by physical exam, sonogram and a blood test called free PSA.
1a) SP Zhao, XP Li. The association of low plasma testosterone level with coronary artery disease in Chinese men. International Journal of Cardiology 63: 2(JAN 31 1998):161-164.
1b) D Simon, MA Charles, K Nahoul, G Orssaud, J Kremski, V Hully, E Joubert, L Papoz, E Eschwege. Association between plasma total testosterone and cardiovascular risk factors in healthy adult men: The telecom study. Journal of Clinical Endocrinology and Metabolism 82:2(FEB 1997):682-685. Some doctors give the low dose injections of 25 mg of testosterone cypionate or enanthate every 2 weeks. The treatment for men who have almost no testosterone is 10 times that dosage. A normal male produces the equivalent of 100 mg of testosterone (enanthate) each week.
1c) RR Hajjar, FE Kaiser, JE Morley. Outcomes of long-term testosterone replacement in older hypogonadal males: A retrospective analysis. Journal of Clinical Endocrinology and Metabolism. 82: 11 (NOV1997):3793-3796. Address JE Morley, St Louis Univ, Hlth Sci Ctr, Dept Internal Med, Div Geriatr Med, 1402 S Grand Blvd, Room M238, St Louis, MO 63104 USA.
2) R Sih, JE Morley, FE Kaiser, HM Perry, P Patrick, C Ross. Testosterone replacement in older hypogonadal men: A 12-month randomized controlled trial. Journal of Clinical Endocrinology and Metabolism 82: 6(JUN 1997):1661-1667.
3) FCW Wu, TMM Farley, A Peregoudov, GMH Waites, GY Zhang, GZ Li, EM Wallace, HWG Baker, XH Wang, JC Soufir, CA Paulsen, C Gottlieb, DJ Handelsman, I Hutaniemi. Effects of testosterone enanthate in normal men: Experience from a multicenter contraceptive efficacy study. Fertility and Sterility 65: 3 (MAR 1996):626-636.
4) DA Schow, B Redmon, JL Pryor. Male menopause - How to define it, how to treat it. Postgraduate Medicine 101: 3 (MAR 1997):62.
5) BS Uyanik, Z Ari, B Gumus, R Yigitoglu, T Arslan. Beneficial effects of testosterone undecanoate on the lipoprotein profiles in healthy elderly men - A placebo controlled study. Japanese Heart Journal 38: 1 (JAN 1997):73-82.
6) Tenover JS. Androgen administration to aging men. Clinical Andrology 1994(Dec);23(4):877-891.
7) Annual Endocrine Society Meetings Washington, D.C. June, 1995.
8) JE Morley, FE Kaiser, R Sih, R Hajjar, HM Perry. Testosterone and frailty. Clinics in Geriatric Medicine 13: 4 (NOV 1997):685.
9) KCB Tan, SWM Shiu, RWC Pang, AWC Kung. Effects of testosterone replacement on HDL subfractions and apolipoprotein A-I containing lipoproteins. Clinical Endocrinology 48: 2 (FEB 1998):187-194.
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