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The Positive Effects of testosterone on the Heart
by Doug Kalman MS, RD
steroids will cause your kidneys to implode, your heart to blow a ventricle, and
your liver to squirt out of your arse, fly across the room, and knock the cat
off the futon. We read it on the Internet and saw an after school special about
it, so it must be true, right?
Actually, the more you learn about steroids, the more you come to realize that,
like all drugs, there's a difference between their intelligent use and outright
abuse. In this article, Doug Kalman takes a look at the effects of testosterone
on the heart. What he found may surprise you.
Over the years we've all heard the repeated mantra that anabolic steroids are
bad for the heart. Some physicians will tell you that gear raises your risk of
heart disease by lowering your good cholesterol (HDL) and raising your bad
cholesterol (LDL). In fact, as some docs will tell you, steroids are known to
even induce cardiac hypertrophy (enlargement of the heart). And since you can't
flex your heart in an effort to woo women, who'd want that?
But, as in every story, there's more than one side. In fact, let it be said, the
dangers of steroids are overstated and, hold onto your seats, may even be good
for the heart. Let's examine some of the scientific studies on the positive
effects of testosterone on the heart.
What are the cardiovascular effects of steroids?
Cardiologists at the Royal Prince Alfred Hospital in Australia recruited both
juicing and non-juicing bodybuilders for a study. Each bodybuilder had various
aspects of the heart measured (carotid intima-media thickness, arterial
reactivity, left ventricular dimensions, etc.). These measurements indicate
whether bodybuilding, steroid usage or both affect the function, size, shape and
activity of the heart.
The doctors found some obvious and not so obvious results. Predictably, those
bodybuilders who used steroids were physically stronger than those who didn't.
What was surprising was that the use of steroids was not found to cause any
significant changes or abnormalities of arterial structure or function.
In essence, when the bodybuilders (both groups) were compared with sedentary
controls, any changes in heart function were common to bodybuilders. The take
home message from this study is that bodybuilding itself can alter (not impair)
arterial structure/function and that steroids do not appear to impair cardiac
function. (1)
Does MRFIT need a T boost?
A famous cardiac study was published about 10 years ago. It soon became on
ongoing study known as the Multiple Risk Factor Intervention Trial (MRFIT). The
present study examined changes in testosterone over 13 years in 66 men aged 41
to 61 years. The researchers determined if changes in total testosterone are
related to cardiovascular disease risk factors.
The average testosterone levels at the beginning of the study were 751 ng/dl and
decreased by 41 ng/dl. Men who smoked or exhibited Type A behavior were found to
have even greater decreases in T levels. The change in testosterone was also
associated with an increase in triglyceride levels and a decrease in the good
cholesterol (HDL).
The authors concluded that decreases in testosterone levels as observed in men
over time are associated with unfavorable heart disease risk. (2) Sounds to me
like a good reason to get T support/replacement therapy in the middle age years!
In a similar study, researchers in Poland examined if testosterone replacement
therapy in aging men positively effected heart disease risk factors. Twenty-two
men with low T levels received 200 mg of testosterone enanthate every other week
for one year. Throughout treatment, testosterone, estradiol, total cholesterol,
HDL and LDL were measured.
The researchers determined that T replacement returned both testosterone and
estradiol levels back to normal and acceptable levels. They also found that T
replacement lowered cholesterol and LDL (the bad cholesterol) without altering
HDL (the good cholesterol). Furthermore, there was no change in prostate
function or size.
The take home message from this study is that T replacement doesn't appear to
raise heart disease risk and it may actually lower your risk. (3) It appears
that more physicians should be prescribing low dose testosterone to middle age
and aging men for both libido, muscle tone and for cardiac reasons.
What about younger men?
It's been long established that men have a higher risk of heart disease. One of
the risk factors implicated is testosterone. Reportedly, the recreational use of
testosterone can alter lipoprotein levels and, in fact, case reports exist
describing bodybuilders who've abused steroids and have experienced heart
disease or even sudden death. But the question remains, is the causal
association one of truth or just an association?
To answer this, researchers at the University of North Texas recruited twelve
competitive bodybuilders for a comprehensive evaluation of the cardiovascular
effects of steroids. Six heavyweight steroid-using bodybuilders were compared
with six heavyweight drug-free bodybuilders.
As expected, the heavy steroid users had lower total cholesterol and HDL levels
as compared to the drug-free athletes. What was unexpected was that the steroid
users also had significantly lower LDL (the bad cholesterol) and triglyceride
levels as compared to the non-steroid users. In addition, the juicers also had
lower apolipoprotein B levels (a marker for heart disease risk). Thus, the
authors concluded that androgens do not appear to raise the risk of
cardiovascular disease. (4) The take home message from this study is that the
negative cardiac side effects of steroids are most likely overstated.
In a little more progressive study, researchers at the Albert Einstein College
of Medicine in the Boogie Down Bronx (the BDB to those in the know) examined
testosterone as a possible therapy for cardiovascular disease. (5) The
researchers note that T can be given in oral, injectable, pellet and transdermal
delivery forms. It's noted that injections of testosterone (100 to 200 mg every
two weeks) in men with low levels of T will decrease total cholesterol and LDL
while raising the HDL.
In fact, testosterone therapy has been found to have antianginal effects
(reduces chest pain). Low levels of testosterone are also correlated with high
blood pressure, specifically high systolic pressure. The researchers determined
that returning T levels back to normal and even high-normal levels have positive
cardiovascular effects and should be considered as an adjunctive treatment for
maintaining muscle mass when someone has congestive heart failure.
Putting it all together
Strong research demonstrates that the risks of negative cardiovascular effects
of steroids are overstated. In fact, a recent paper published in the Canadian
Journal of Applied Physiology questioned the whole risk of using steroids. (6)
Joey Antonio, Ph.D. and Chris Street MS, CSCS published strong data showing that
the risks of steroid use are largely exaggerated, much like scare tactics used
by your parents while you were a kid. Of course, it goes unsaid that abuse of
anything will lead to unwanted consequences.
We know that as we age, circulating testosterone levels naturally decrease. For
most people the testosterone decrease goes from high-normal to mid to low
normal. Data shows that there's an inverse relationship between T levels and
blood pressure as well as abdominal obesity (that paunch we see on so many
middle age males).
testosterone replacement lowers abdominal obesity and restores testosterone back
to normal levels. Restored testosterone is correlated with better mood, better
muscle tone, stronger sex drive, lower cardiovascular disease risks, stronger
bones and better memory. It's important to note that while conservative use
gives a pronounced positive health benefit, higher doses may not necessarily
lead to further health benefits.
What to do
If you see your body composition changing (your gut starts looking like your
Uncle Lester's), your strength or muscle tone diminishing despite your hard
training and good diet, and your sex drive not matching up to TC's columns, have
your testosterone levels checked. The acceptable normal range for testosterone
to physicians is 300 mg/dl to 1100 mg/dl. Yes, that's a pretty wide range.
In the clinic, we see people with the complaints consistent with "andropause" (a
term for male menopause) and/or increased cardiovascular risk having
testosterone levels between 300 mg/dl and 550 mg/dl. Bringing it up to the mid
to high-normal level is what gives the health and "youthful" benefits.
Traditionally 200 mg/dl of supplemental testosterone given every one to two
weeks improves body composition, lowers total cholesterol and LDL, while raising
HDL.
It appears that supplemental T is a healthier and safer way to go than many of
the drugs used to treat poor lipid profiles. The data presented in this article
applies for males over 35, not those who are 18. If you think that you can
benefit from testosterone therapy look for physicians who market themselves as
"anti-aging" or "longevity physicians" as well as the more progressive
endocrinologists or cardiologists.
Long story short, used intelligently, testosterone is good medicine!
About the author: Douglas S. Kalman MS, RD is a Director for Miami Research
Associates (MiamiResearch.com) a leading pharmaceutical and nutrition research
organization in Miami, Florida. Doug is also a national spokesperson for the
American College of Sports Medicine and according to his latest test has high T
levels. Doug can be reached at dknole@hotmail.com.
References:
1) Sader MA, Griffiths KA, McCredie RJ, et al. Androgenic anabolic steroids and
arterial structure and function in male bodybuilders. J Am Coll Cardiol
2001;37(1):224-230.
2) Zmuda JM, Cauley JA, Kriska A, et al. Longitudinal relation between
endogenous testosterone and cardiovascular disease risk factors in middle aged
men. A 13 year follow-up of former Multiple Risk Factor Intervention Trial
participants. Am J Epidemiol 1997;146(:609-617.
3) Zgliczynski S, Ossowski M, Slowinska-Srednicka J, et al. Effect of
testosterone replacement therapy on lipids and lipoproteins in hypogonadal and
elderly men. Atherosclerosis 1996;121(1):35-43.
4) Diekerman RD, McConathy WJ, Zachariah NY. testosterone, sex hormone-binding
globulin, lipoproteins and vascular disease risk. J Cardiovasc Risk
1997;4(5-6):363-366.
5) Shapiro J, Christiana J, Frishman WH. testosterone and other anabolic
steroids as cardiovascular drugs. Am J Ther 1999;6(3):167-174.
6) Antonio J, Street C. Androgen use by athletes: A reevaluation of the health
risks. Can J Appl Physiol 1996;21(6):421-440
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