It is often stated that certain conditions, such as low testosterone, can increase one’s risk of death.  This is a ridiculous statement, because everyone’s risk of death is 100%, thus it is guaranteed and cannot be increased.  Nevertheless, certain habits, behaviors, lifestyles, environments, foods, drugs, diseases, and even conditions can in fact increase the speed with which one reaches that inevitable death.  Low testosterone, also known as hypogonadism, is just such a condition.  Although low testosterone is not the direct cause of early death risk itself, current research suggests that it is in fact linked to cardiovascular disease and can therefore increase one’s risk of dying prematurely.

Heart disease is now a worldwide epidemic – tending to affect a disproportionately large number of human beings within a region, community or population at the same time.  According to the United States Center for Disease Control:

• 2009 estimated data places the annual U.S. death rate from cardiovascular disease at approximately 600,000 people, or 1 in every 4 deaths per year.
• Based on 2009 estimates, the leading cause of death for both men and women (more than half of which occur in men) is cardiovascular disease.
• Using estimates as late as 2013, each year approximately 715,000 Americans experience a heart attack, of which 525,000 are a first heart attack and 190,000 happen in people who have already had a heart attack.
• 2011 estimated data places the U.S. costs for coronary heart disease at $108.9 billion per year, which also includes the cost of medications, healthcare services and, and lost productivity.

According to WebMD, researchers currently cite stroke as the United States’ third largest cause of death, with an actual stroke occurring rate of one person (in the U.S.) every 45 seconds.  The website expands on this by stating that strokes accounted for more than 1 of every 15 U.S. deaths in the year 2001, and represents one of the leading causes of disability.

Research on Low Testosterone and Mortality

Recently, researchers have discovered a correlation (relationship) between heart disease and low testosterone.  According to study author and researcher Dr. Johannes Ruige, M.D., Ph.D., of Ghent University Hospital in Belgium was able to identify links between low testosterone and atherosclerosis (a hardening and thickening of the walls within arteries), and a modest link between low testosterone and heart attacks.  Dr. Ruige went on to express being hopeful that less frequently investigated events may also play a role and come to light, events such as:  thrombosis – a condition wherein a blood clot develops within the circulatory system; and arrhythmia – a condition wherein an irregular heart beat develops.

Ruige and her colleagues published a study in the June 2011 journal ‘Heart’ (the British Cardiac Society journal) entitled, ‘Endogenous testosterone and cardiovascular disease in healthy men: a meta-analysis’.  The stated objective was to estimate the predictive value of testosterone for cardiovascular disease and to identify study features explaining conflicting results.  This meta-analytical study (secondary research conducted on several primary research studies) consisted of eligible population-based cohorts and nested case-control studies on low testosterone in association with atherosclerosis, stroke, myocardial infarction, ischaemic heart disease, mortality, and death from coronary heart disease.  After identifying 19 potentially eligible articles, a weak independent association was found in conjunction with total testosterone levels.  Variables within the study that served as modifiers, ways in which to create subsets, included the age (used to include men over 70 years of age) and publication year.  Ruige concluded that the latter studies, those published after January 2007, showed a particularly pronounced association (relationship) between low testosterone and cardiovascular disease, and the results were largely confirmed by separate analyses of free- and bioavailable testosterone.

In December of 2007, KT Khaw and colleagues of the Clinical Gerontology Addenbrooke’s Hospital, Cambridge, UK published a study in the journal Circulation entitled, ‘Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study’.  This study was prompted due to the (at the time) still controversial relationship between endogenous testosterone levels and male health.  Researchers examined the prospective relationship between endogenous (natural) testosterone concentrations and mortality (death rates) due to all causes of cardiovascular disease and cancer in a nested case-control study based on 11,606 men with ranges from 40 to 79 years of age.  The men were surveyed from 1993 to 1997, and then participated in a follow up survey in the year 2003.  During the follow up it was found that 825 of the subjects without prevalent cancer or cardiovascular disease had died.  This no longer living group was then subsequently compared with a control group, which consisted of 1489 still alive subjects, and matched for age and date of baseline visit.  After researchers further adjusted the remaining variables, namely age, social class, education cigarette smoking, diabetes mellitus, systolic blood pressure, date of visit, body mass index, blood cholesterol, dehydroepiandrosterone sulfate, androstanediol glucuronide, sex hormone binding globulin (SHBG), alcohol intake, and physical activity it was determined that natural testosterone concentrations were inversely related to mortality due to the 825 all causes deaths, the 369 cardiovascular disease deaths, and the 304 cancer deaths.  Researchers generated odds ratios with 95% confidence intervals, and concluded that in their male subjects endogenous testosterone concentrations are inversely related to death/mortality due to cardiovascular disease and all causes related deaths, and that low testosterone appears to be an accurate predictive marker for those at high risk of cardiovascular disease related death.

According to Robert Davis, MD, professor of urology at the University of Rochester, N.Y. these findings make perfect sense.  He contends that low testosterone is common among men with metabolic syndrome – a condition of risk factors including low HDL cholesterol, high blood-fat levels, high blood pressure, abdominal fat, and high blood sugar.  Dr. Davis says that he’s not surprised at this finding, and that research has shown the correlation between low testosterone metabolic syndrome, which is related to diseases like diabetes, heart disease, and vascular disease, definitely exists.  He believes that testosterone levels in people with metabolic syndrome should be checked, and that more physicians should recognize its importance.

Other Health-Related Low Testosterone Conditions

Granted men are testosterone-based, and low testosterone has been found to contribute to heart disease, but are men more susceptible to this disease for other reasons?  Some research suggest that they are, in fact such research goes on to outline the factors which make men more predisposed to heart conditions than women.

Furthermore, studies like the one conducted by CR Gale and his colleagues supports the even greater divide that among men, arguing that intelligence plays a role in the development of heart disease and eventual early death.  In the July 2012 Journal of Epidemiology Community Health, CR Gale, et al of the MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK published a study entitled, ‘Intelligence in early adulthood and subclinical atherosclerosis in middle-aged men: the Vietnam Experience Study’.  Functioning under the premise that people with higher intelligence in early life have a lower subsequent risk of coronary heart disease events, the expressed study aims were to examine whether intelligence in early adulthood is associated with risk of subclinical atherosclerosis in mid-life, as indicated by a test used to predict the severity of arterial disease called the ankle brachial index (ABI), and to investigate its potential mediating role in the association between intelligence and mortality.  This study was comprised of 4,286 male participants all of whom were US veterans whose intelligence was measured at the time of military enlistment (at the mean age of 20.4 years), and for whom ABI was again administered at age 38 by Doppler as part of a detailed follow up medical examination.  Researchers then adjusted their measures to account for a diversity of variables like body mass index, smoking, blood pressure, socioeconomic position, serum cholesterol, triglycerides, glucose concentrations, alcohol intake, education, age, and erythrocyte sedimentation rate all of which had little or no effect on the results.  The very interesting results demonstrated that higher intelligence in early adulthood was associated with a higher ABI in mid-life, and showed an increase in intelligence.  In other words, higher intelligence equaled a lower risk of heart disease.

In addition to its life threatening nature, low serum testosterone has been correlated with a variety of quality of life diminishing symptoms as well.  Such hypogonadic symptoms, which can also serve as an early alert for a more serious life threatening problem include numerous adverse symptoms like:  diminished cognitive faculties such as concentration and focus, memory and recall, often described as brain fog; a reduction in sexual performance, libido or arousal, the inability to achieve and or sustain rigid erections; reduced bone and muscle mass, along with diminished muscular strength; increased depression, anxiety, and irritability; an increased resistance to insulin; increasing overall body fat and fatty deposits; poor overall sleep quality, including the inability to get to, stay, and achieve latter (deeper and more satisfying) stages of sleep; etc.  Testosterone replacement therapy administration (TRT) is being investigated as a treatment in more serious life threatening conditions, and has already been proven highly effective in remedying mild and moderate hypogonadic symptoms as evidenced by the studies below:

• In September 2003 the Journal of North American Menopause published a study by R. Goldstat, et al of the Jean Hailes Foundation Research Unit, Clayton, Victoria, Australia entitled, ’Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women’.  The expressed aim of this study was to examine the effects of transdermal testosterone replacement therapy on testosterone deficient women suffering from premenopausal physiological decline, specifically defined as mood, well-being, sexual function, and libido.  R. Goldstat, et al found that testosterone replacement therapy significantly improved sexual function, well-being, libido, and mood in premenopausal women with a diagnosis of low testosterone.

• In June of 2006 D. Kapoor, et al of the Centre for Diabetes and Endocrinology, Barnsley NHS Foundation Trust Hospital, Gawber Road, Barnsley S75 2EP, UK published a study in the European Journal of Endocrinology entitled, ‘Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes’.  The aim of this study was to investigate the effect of testosterone replacement therapy on insulin resistance, and glycaemic control in hypogonadal men with type 2 diabetes.  D. Kapoor, et al concluded that testosterone replacement therapy was responsible for both reducing insulin resistance, and improving glycaemic control in hypogonadal men with type 2 diabetes.  Additionally, this study revealed marked improvements in cholesterol and visceral adiposity (loss of between organs body fat), all of which when combined represent a reduced risk of cardiovascular disease.

• In November of 2009 the Arquivos Brasileiros de Endocrinologia e Metabologia published a study by ES Andrade Jr., et al entitled, ‘Short term testosterone replacement therapy improves libido and body composition’.  The aim this study was to investigate the safety and efficacy of testosterone replacement in adult male subjects with late-onset hypogonadism.  As compared to the control groups (after only eight weeks), the experimental group returned a greater decrease in waist circumference, greater sexual potency improvement, and greater libido improvement.

• In November of 2012 the Chinese Medical Journal published a study by XW Zhang, et al of the Department of Urology, Peking University People’s Hospital, Beijing, China entitled, ‘Androgen replacement therapy improves psychological distress and health-related quality of life in late onset hypogonadism patients in Chinese population’.  They concluded that testosterone replacement therapy both improved a variety of hypogonadic symptoms, and comprehensively enhanced the improvement of psychological issues as well.

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