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“There needs to be that other voice saying there’s no medication out there with all benefit and no risk. There’s always a trade off.” Anne R. Cappola, MD, ScM, Perelman School of Medicine, University of Pennsylvania, and associate editor of the Journal of the American Medical Association (Bloomberg.com/news, November 5, 2013)
“Rational people should be thinking about this, like ‘Wait a minute. Do I really want to take this?’” Bradley Anawait, MD, endocrinologist and Professor of Medicine, University of Washington (NBCNews.com, November 5, 2013)
Testosterone Replacement Ups Heart & Stroke Risk by 30 Percent
New Study Warrants Caution, But Application to Younger, Healthier Men Is Unclear
Plus an Example of Lifestyle in Action
We have worrisome news about testosterone replacement therapy, which makes it a good time to tell you about my testosterone readings using lifestyle alone. Wellbeing, risk, and money are in play.
The benefits and risks are slowly emerging as the market for “Low T” drugs grows apace. Almost 3 percent of men aged 40 or older have been prescribed testosterone, NBC News reported. According to figures compiled by BloombergBusinessweek, sales of testosterone drugs could reach $5 billion by 2017.
The latest study, reported in the November 6, 2013 Journal of the American Medical Association, found that testosterone therapy raised the risk of heart attack, stroke or death by 30 percent in a group of veterans with testosterone 300 ng/dl or less, who had undergone coronary angiography. The men in the study were over 60 and, by definition, had heart symptoms of some kind.
Out of 8709 men with low testosterone (<300), 1223 had testosterone therapy. The men given testosterone were slightly younger, mean age 60.6 compared to 63.8, and slightly healthier then the 7486 not given testosterone. During a three year follow up period, 26% of the men given testosterone suffered a heart attack, stroke or death, compared to 20% of those not taking testosterone.
Importantly, the 30% difference in risk was the same for men with and without coronary artery disease, as determined by coronary angiography, a procedure that uses dye and X-ray to look inside heart arteries and measure plaque buildup.
Medical problems can cause testosterone levels to fall sharply in younger men. But hormone levels also decline naturally with age—roughly 10% per decade for healthy men. Experts differ on which men should be treated. (See article # 193 on this website)
Journalist Andrew Sullivan is a case where most experts would probably agree that testosterone replacement therapy was appropriate—and successful. Featured in a piece about the new study on nbcnews.com, 35-year-old Sullivan was suffering from the effects of anti-HIV medications and found to have a testosterone level below most 80-year-olds. “Sullivan began taking testosterone injections and was transformed,” Brian Alexander wrote for NBC News. Now 50, Sullivan takes testosterone using four-month implants. “I have energy, am leaner, have more muscle mass, am motivated to work out and can sustain the kind of focus that a blog like mine demands,” he wrote in an email to Mr. Alexander.
Predictably, most cases are not so clear cut. The new study, overseen by Dr. Michael Ho, a cardiologist with the VA Eastern Colorado Health Care System, helps doctors and patients decide whether testosterone replacement is appropriate, but many questions remain. “Men taking testosterone have to ask themselves whether the risks are worth the benefits they may receive,” Ho told the Wall Street Journal.
“The most important question is the generalizability of the results of this study to the broader population of men taking testosterone,” Dr. Anne Cappola wrote in an editorial published along with the study. The application of the new findings to “men of this age group who are taking testosterone for ‘low T syndrome’ or for antiaging purposes and younger men taking it for physical enhancement” is unclear.
“In light of the high volume of prescriptions and aggressive marketing by testosterone manufacturers, prescribers and patients should be wary,” Cappola concluded.
(For more information on testosterone risks and benefits see articles # 273 & # 368 on this website.)
* * *
While we’re waiting for more clarity, I’ll tell you my results with healthy eating and regular exercise. We don’t have all the facts on what factors control testosterone level, but lifestyle has worked for me; see my photo in everyday condition at 76: www.cbass.com/ClarenceBass76.htm
My health and fitness have been evaluated regularly at the Cooper Clinic in Dallas since 1988, when I was 50 years old. My testosterone was measured for the first time in 2000, when I was 62; it was normal at 483 ng/dl. The reference range was 241-827. Interestingly, my latest test, in 2012, at 74, was slightly higher, at 491.
My low reading was an unexplained 326 in 2008; a retest showed a return to normal at 451. The high was 566 in 2011, also unexplained.
If my case is any indication, testosterone doesn’t have to fall with age. Testosterone replacement therapy may not be necessary. Lifestyle measures may produce as good or better results.
“Most of what we call aging is decay, and decay is optional,” Henry S. Lodge, MD, wrote in Younger Next Year (Random House, 2004). “It’s under your control” I agree with Dr. Lodge, and included his hypothesis in my book Great Expectations.
Our genes are programmed for survival of the species. Our body and brain are designed for life in nature, where only the fittest survive. Nature’s purpose is simple, and brutal: to provide for the next generation. Food was in short supply and needed for childrearing and productive members of the group.
“Biologically, there is no such thing as retirement, or even aging,” Lodge wrote. “There is only growth or decay.” And sedentary living, so common in modern times, is “the most important signal for decay.” Exercise, on the other hand, signals growth. “It’s spring and time to grow.”
It's logical to assume that the strongest signals come from high intensity exercise, both strength and endurance.
I’ve written about many studies which lay out the fitness and health benefits of high-intensity exercise, and I don’t believe anyone has done a better job of painting the big picture than Dr. Mark C. Houston, a professor of clinical cardiology at the Vanderbilt University School of Medicine. In his book Heart Disease, Houston explains how exercise can alter the way many genes function and interact with your cells. Unfortunately, many people are doing the wrong kind of exercise.
The problem is that the focus is on exercising the heart and burning calories, when it should be on challenging the muscles. When muscles move, Houston tells us, “they release powerful messenger molecules that ‘speak’ to every organ in the body and determine whether oxidation and inflammation are encouraged or discouraged, fat is burned or stored, new tissue is created, and much more.”
The kind of exercise you do is important, because not all exercise has the same effect on genetic signaling. The contrast between sprinters and marathon runners speaks volumes. “While the short, intense activity of sprinting does not burn many calories, it triggers the release of adrenaline, human growth hormone, cortisol, and testosterone,” Houston writes.
I’ve read (and written) about this before—I encouraged high-intensity muscular effort in aerobic exercise sessions for the first time in Ripped 3—but not from a clinical professor of cardiology at a highly rated medical school.
Your muscles are always talking, says Dr. Houston. What they’re saying depends on what you’re doing. “High-intensity exercise gets the muscles talking the most,” he writes. “Exercise using full body movements, incorporating great amounts of muscle, requiring a combination of strength and endurance, and forcing the muscles to do lots of work in a little bit of time cause the muscles to shout out a unique message that sets in motion a powerful muscle-building, fat-burning, anti-inflammatory, and brain-stimulating effect,” he tells readers.
Dr. Houston lists some of the key molecules of “Muscle Talk” and describes the messages they send.
Interleukin-6 (IL-6) promotes fat burning and controls inflammation. IL-6 informs the body about the muscle’s current and future energy needs. “The most powerful metabolic signaling agent released from muscle, it is sent out as soon as muscle starts to contract and move. It’s released in even greater amounts as the activity becomes more intense,” Houston writes. “IL-6’s actions help dampen inflammation, raise testosterone and growth hormone, increase fat burn, regulate glucose, reduce weight, increase muscle mass, fine-tune fuel metabolism, and reduce the risk of heart disease and stroke.”
Perhaps even more important and surprising, Houston tells us that new research shows that lactic acid circulating through the blood acts like a hormone, stimulating the release of testosterone and growth hormone, the two powerful growth promoters that make the body stronger, leaner, and more functional. In addition, lactic acid signals the muscle cells to increase the number of mitochondria (energy factories) within the cells, meaning the body can burn more fat to produce more energy to support bodily functions.
“Unfortunately,” Dr. Houston writes, “most people avoid lactic acid like the plague, opting for slower and lower-intensity forms of exercise, like jogging or peddling a bike. But only intense bursts of activity that trigger ‘the burn’ can get the muscles talking to the rest of the body and forcing it to adapt and grow.”
For more about the metabolic effects of high-intensity exercise—and how I train to implement Dr. Houston’s prescription, see my article Muscle Talk: http://www.cbass.com/MuscleTalk.htm
I have modified the routines described in Dr. Houston’s book to suit my needs. My training is shorter and less frequent than he recommends. Intensity/effort, however, is not lacking. As Dr. Houston recommends, my training forces the muscles of the whole body to do lots of work in a little bit of time.
Importantly, it seems to be working—and it makes me happy, a key factor in the success of any routine.
WARNING: If you are not used to exercising or have health concerns of any type, don’t try this without discussing it with your doctor.
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