Testosterone is an essential hormone that plays a vital role in men’s health. It helps regulate sex drive, muscle mass, bone density, fat distribution, and red blood cell production. In recent years, there has been increasing interest around the effects of low testosterone, also known as hypogonadism or “low T.” Some men who have low testosterone levels experience symptoms like decreased sex drive, erectile dysfunction, depressed mood, and reduced muscle mass. There has also been speculation that low testosterone may increase a man’s risk for cardiovascular disease.
What causes low testosterone?
Testosterone production naturally declines as men age, typically about 1% per year after age 30. Other potential causes of low testosterone include:
- Injury or infection to the testicles
- Chemotherapy or radiation treatment
- Medications like opioids or steroids
- Chronic illness
- Obesity
- Type 2 diabetes
- Pituitary gland disorders
- Inflammatory conditions
- Genetic conditions like Klinefelter syndrome
Lifestyle factors like chronic stress, alcohol abuse, and poor nutrition can also negatively impact testosterone levels. Diagnosing low T involves a blood test to check total and free testosterone levels.
Symptoms of low testosterone
Some common symptoms and signs that a man may have low T include:
- Reduced sex drive and erectile dysfunction
- Decreased energy and fatigue
- Loss of muscle mass
- Increased body fat
- Mood changes like irritation or depression
- Difficulty concentrating or “brain fog”
- Reduced strength and endurance
- Thinning or loss of body and facial hair
- Reduced bone density or osteoporosis
However, having one or more of these symptoms does not necessarily mean that low testosterone is to blame. Many other medical conditions can cause similar signs and symptoms.
Does low testosterone increase heart disease risk?
There has been extensive research around the possible connection between low testosterone and cardiovascular disease in men. Some key points from the research include:
- Having very low testosterone levels (less than 200 ng/dL) appears to be linked with higher rates of cardiovascular disease and mortality in older men, according to several observational studies.
- Middle-aged and older men with angiographically-confirmed coronary artery disease tend to have lower testosterone than men with normal coronary arteries.
- Men with congestive heart failure, coronary artery disease, or a history of heart attacks tend to have lower than normal testosterone.
- Lower testosterone levels are correlated with higher blood pressure, insulin resistance, obesity, and cholesterol levels, which are all risk factors for heart disease.
- Testosterone therapy has been shown to improve some cardiovascular risk factors like body composition, cholesterol values, and inflammatory markers in men with hypogonadism.
- However, research results are mixed as to whether boosting testosterone levels actually lowers heart disease rates or mortality.
Possible mechanisms
There are a few potential explanations for why low testosterone may contribute to cardiovascular disease:
- Atherosclerosis – Testosterone helps relax blood vessels and keep them flexible. Low levels may accelerate plaque buildup and cholesterol deposits in the arteries.
- Blood flow – Healthy testosterone helps dilate blood vessels to boost circulation. Low T may reduce blood flow.
- Inflammation – Testosterone helps regulate inflammation levels in the body. Too little may lead to increased inflammation and cytokine production, which can damage the arteries.
- Metabolic syndrome – Low testosterone is linked with insulin resistance, visceral fat gain, high blood sugar, and hypertension.
- Heart muscle – Testosterone impacts heart muscle cell function and growth. Low levels may lead to reduced cardiac output.
Low testosterone treatment options
For men diagnosed with clinically low testosterone, treatment may help manage symptoms and reduce cardiovascular risks. Options include:
- Testosterone replacement therapy (TRT) – This involves medications like injections, gels, patches or pellets to restore testosterone levels to normal range. TRT can be very effective at alleviating low T symptoms when properly monitored by a physician.
- Lifestyle changes – Losing weight, improving diet, reducing stress, exercising regularly, limiting alcohol intake, and quitting smoking can help boost natural testosterone production.
- Medications – Drugs that target some causes of low T like opioid analgesics, steroids, and antidepressants may be discontinued or changed.
- Treatment of underlying conditions – Managing illnesses like Type 2 diabetes, sleep apnea, liver or kidney disease, tumors, or genetic disorders may help normalize testosterone levels.
However, testosterone therapy does have some risks like acne, enlarged prostate, and increased red blood cell concentration. It’s also unclear how long-term treatment affects the heart. Careful monitoring and blood testing helps reduce adverse effects.
Heart-healthy lifestyle tips for low testosterone
All men with low testosterone should engage in heart-healthy lifestyle and diet changes, including:
- Following a Mediterranean-style diet focused on unsaturated fats, whole grains, fruits and vegetables.
- Engaging in regular moderate exercise like brisk walking 30 minutes per day.
- Reaching or maintaining a healthy body weight.
- Managing stress through techniques like yoga, meditation, or tai chi.
- Getting adequate sleep daily.
- Drinking alcohol only in moderation.
- Quitting smoking to improve heart and testosterone health.
Simple nutritional strategies like eating heart-healthy fats, limiting sugar, reducing processed carbs, and increasing protein intake can help balance testosterone levels.
The bottom line
In summary, research indicates that very low testosterone levels may contribute to increased cardiovascular risk in older men. Exactly how hypogonadism impacts the heart is not fully understood. However, early detection and managing low T through lifestyle changes, targeting underlying causes, and testosterone replacement under medical supervision may help reduce potential heart problems.
While more research is still needed on the effects of testosterone therapy, the evidence so far indicates it can have modest benefits for men with clinically low testosterone levels. As always, men should speak to their doctor about whether testing and treatment for low testosterone is appropriate for their individual health status.