Low Testosterone Levels are Associated with Coronary Artery Disease

Researchers say that low testosterone levels are associated with coronary artery disease in male patients with angina.
Rosano GM, Sheiban I, Massaro R, Pagnotta P, Marazzi G, Vitale C, Mercuro G, Volterrani M, Aversa A, Fini M. Low testosterone levels are associated with coronary artery disease in male patients with angina.Int J Impot Res. 2006 Aug 31

From the study abstract
Historically, high androgen levels have been linked with an increased risk for coronary artery disease (CAD.) However, more recent data suggest that low androgen levels are associated with adverse cardiovascular risk factors, including an atherogenic lipid profile, obesity and insulin resistance.

The aim of the present study was to evaluate the relationship between plasma sex hormone levels and presence and degree of CAD in patients undergoing coronary angiography and in matched controls.

We evaluated 129 consecutive male patients (mean age 58+/-4 years, range 43-72 years) referred for diagnostic coronary angiography because of symptoms suggestive of CAD, but without acute coronary syndromes or prior diagnosis of hypogonadism. Patients were matched with healthy volunteers. Out of 129 patients, 119 had proven CAD; in particular, 32 of them had one, 63 had two and 24 had three vessel disease, respectively. Patients had significantly lower levels of testosterone than controls (9.8+/-6.5 and 13.5+/-5.4 nmol/l, P<0.01) and higher levels of gonadotrophin (12.0+/-1.5 vs 6.6+/-1.9 IU/l and 7.9+/-2.1 vs 4.4+/-1.4, P<0.01 for follicle-stimulating hormone and luteinizing hormone, respectively). Also, both bioavailable testosterone and plasma oestradiol levels were lower in patients as compared to controls (0.84+/-0.45 vs 1.19+/-0.74 nmol/l, P<0.01 and 10.7+/-1.4 vs 13.3+/-3.5 pg/ml, P<0.05). Hormone levels were compared in cases with one, two or three vessel disease showing significant differences associated with increasing severity of coronary disease. An inverse relationship between the degree of CAD and plasma testosterone levels was found (r=-0.52, P<0.01).

In conclusion, patients with CAD have lower testosterone and oestradiol levels than healthy controls. These changes are inversely correlated to the degree of CAD, suggesting that low plasma testosterone may be involved with the increased risk of CAD in men.

Estradiol, Testosterone, and Hip Fractures in Men

Researchers writing in The American Journal of Medicine say “Men with low estradiol levels are at an increased risk for future hip fracture. Men with both low estradiol and low testosterone levels seem to be at greatest risk for hip fracture.”

Estradiol, Testosterone, and Hip Fractures in Men.
Shreyasee A, Zhang Y, Felson DT, Sawin CT, Hannan MT, Wilson PWF, Kiel DP. Estradiol, Testosterone, and the Risk for Hip Fractures in Elderly Men from the Framingham Study. The American Journal of Medicine Volume 119, Issue 5 , May 2006, Pages 426-433

Link Between Testosterone and Prostate Cancer

March 14, 2006
Testosterone Replacement Therapy and the Risk of Prostate Cancer. Is there a link?

Writing in the Canadian Journal of Urology, Researcher Abraham Morgentaler of the Division of Urology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, says that “there is an absence of scientific data supporting the concept that higher testosterone levels are associated with an increased risk of prostate cancer.”

Specifically, no increased risk of prostate cancer was noted in 1) clinical trials of testosterone supplementation, 2) longitudinal population-based studies, or 3) in a high-risk population of hypogonadal men receiving testosterone treatment. Moreover, hypogonadal men have a substantial rate of biopsy-detectable prostate cancer, suggesting that low testosterone has no protective effect against development of prostate cancer.

These results argue against an increased risk of prostate cancer with testosterone replacement therapy.

Morgentaler A.Testosterone replacement therapy and prostate risks: where’s the beef? Can J Urol. 2006 Feb;13 Suppl 1:40-3. Read the abstract

From our December 6, 2005 Newsletter
An article by Susan Brink of the Los Angeles Times recently appeared in newspapers around the country discussing the link between testosterone and prostate cancer.

The article says “The belief that testosterone increases the risk of prostate cancer is so widely accepted that study after study that tries to show it and can’t keeps getting repeated over and over,” says Dr. Abraham Morgentaler, a Boston urologist and author of the 2004 review. “People don’t believe it.”

Here is a press release from the Harvard Medical School.

“Boston–January 2004, Harvard Medical School affiliate Beth Israel Deaconess Medical Center–A retrospective analysis by researchers at Beth Israel Deaconess Medical Center published in The New England Journal of Medicine found no causal relationship between testosterone replacement and prostate cancer or heart disease risk. The comprehensive review of 72 studies, addresses the current controversy about testosterone replacement therapy and its potential health risks to men.”

More Body Mass…Diminished Testosterone

Osuna C JA, Gomez-Perez R, Arata-Bellabarba G, Villaroel V. Relationship between bmi, total testosterone, sex hormone-binding-globulin, leptin, insulin and insulin resistance in obese men. Arch Androl. 2006 Sep-Oct;52(5):355-61

From the study abstract: The objective of this work was to evaluate the relationship between sex steroid hormones, sex hormone-binding-globulin, leptin, insulin and insulin resistance in obese men. Anthropometrical indexes, total testosterone, free testosterone, estradiol, sex hormone-binding-globulin (SHBG), glucemia, insulin and leptin were measured in 77 men, with ages between 20 and 60 years.

According to their body mass index (BMI), subjects were grouped into three categories: normal body weight, overweight and obese group.

Total testosterone and SHBG concentrations were lower in the obese group compared with normal and overweight subjects.

The mean insulin concentration was significantly higher in the obese group compared with the other groups.

Our results shows that in a sample of men, total testosterone and SHBG concentrations proportionally diminished with both the increase of BMI and insulin resistance index.

Androgen Deficiency, Metabolic Syndrome and Non-Obese Men

Researchers writing in The Journal of Clinical Endocrinology and Metabolism report that “Low SHBG, total testosterone, or AD (Androgen Deficiency) may be early markers of MetS (Metabolic Syndrome) in nonobese men, providing a warning sign in men otherwise considered at lower risk of developing MetS and subsequent diabetes or cardiovascular disease.”

From the study: “Low serum SHBG, low total testosterone, and clinical AD are associated with increased risk of developing MetS over time, particularly in non-overweight middle-aged men.”

You can read the abstract here and link to the a free copy of the entire study from there.
Kupelian V, Page ST, Araujo AB, Bremner WJ, McKinlay JB. Low SHBG, Total Testosterone, and Symptomatic Androgen with Development of the Metabolic Syndrome. J Clin Endocrin Metab. January 4, 2006