It is possible for the condition of low testosterone, also known as hypogonadism, to shorten men’s lives.  Although low testosterone does not directly shorten the lives of men like for example prostate cancer, cardiovascular disease, or any of several other well known killers, current research suggests that it is in fact linked to (and therefore a possible cause of) both prostate cancer and heart disease thereby increasing the risk of a prematurely shortening of lifespan.

Cardiovascular disease has become a worldwide epidemic – affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time.  According to the United States Center for Disease Control:

• Using estimates as late as 2009, about 600,000 people die of heart disease in the United States every year, an estimated 1 in every 4 deaths.
• 2009 estimated data places heart disease as the leading cause of death for both men and women.  However, more than half of all cardiovascular disease occurs in men.
• Based on 2013 estimates approximately 715,000 Americans experience a heart attack every year, 525,000 of which represent a first heart attack, and 190,000 of which happen in people who have already had at least one heart attack.
• Using estimates late as 2011, those costs related to coronary heart disease within the United States (i.e., lost productivity, healthcare services, and medications) totaled $108.9 billion per year. 

According to WebMD, stroke alone is the nation’s third largest cause of death and one person in the United States suffers a stroke every 45 seconds.  Furthermore, strokes accounted for more than 1 out of every 15 deaths in the United States in 2001, and are one of the leading causes of disability.

Research on Low Testosterone and Risk of Death

Contemporary researchers have found a definite correlation (relationship) between low testosterone and heart disease.  One researcher and study author Dr. Johannes Ruige, M.D., Ph.D., of Ghent University Hospital in Belgium clearly identified links between atherosclerosis (a hardening and thickening of the walls within arteries) and low testosterone, as well as a modest connection between low testosterone and resultant heart attacks from atherosclerosis.  Furthermore, Dr. Ruige expressed being very hopeful that other less researched events might also be found to play a significant role.  She specifically cited such events as:  thrombosis – a condition in which a blood clot forms within the circulatory system; and arrhythmia – a condition in which the heart beats at an irregular rate.

In June of 2011 Ruige et al (and colleagues) published a study in ‘Heart’ (the British Cardiac Society journal) entitled, ‘Endogenous testosterone and cardiovascular disease in healthy men: a meta-analysis’.  The principle aim of this study was to estimate the predictive value of testosterone for heart disease and to see if any of the study features are capable of explaining contradictory results.  This secondary research conducted on several primary research studies (meta-analytical) was comprised of both eligible cohorts (population-based subjects that are followed throughout a study), and nested case-control studies (those which maintain non-experimental groups as a control for comparison) on low testosterone and its relationship to myocardial infarction, ischaemic heart disease, atherosclerosis, stroke, death from coronary heart disease, and general mortality.  The researchers were able to identify a weak independent association between these conditions and low testosterone within a total of 19 potentially eligible study articles.  Modifying variables within the study (those factors which the researchers were able to change in order to look at the data from different perspectives), included the age which was used to include men over 70 years old and publication year (when the studies were published within journals).  Ruige concluded that the latter studies, more specifically the ones published later than January 2007, showed a substantial association (relationship) between low testosterone and cardiovascular disease, the results of which were confirmed by separate analyses of both bioavailable and free-testosterone levels.

In December of 2007 the journal Circulation published a study by KT Khaw et al of the Clinical Gerontology Addenbrooke’s Hospital, Cambridge, UK 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’.  Prompted by the still controversial (at the time) relationship between endogenous (naturally occurring within the body) testosterone concentrations and male health, Khaw et al examined the possible relationship between testosterone concentrations and death rates from all causes, which included cancer and heart disease in a nested case-control study.  The study contained a total of 11,606 men who were surveyed from 1993 to 1997, later participated in a follow up survey in the year 2003, and who ranged in age from 40 to 79 years old.  By the time of the 2003 follow up survey, 825 of the subjects without heart disease or prevalent cancer had died.  This 825 member deceased group then compared to a control group consisting of 1,489 living subjects who were matched by date of baseline visit and age.  The researchers then further adjusted additional variables including age, systolic blood pressure, dehydroepiandrosterone sulfate, androstanediol glucuronide, physical activity, sex hormone binding globulin (SHBG), alcohol intake, date of visit, body mass index, social class, education, cigarette smoking, diabetes mellitus, and blood cholesterol it was determined that natural testosterone levels were directly linked to mortality in the 304 cancer deaths, the 369 cardiovascular disease deaths, and the 825 all causes of death groups.  KT Khaw also pointed out that low testosterone appeared (in their study) to be a good determiner for those who are at a higher risk for death related to heart disease.

Agreeing with these findings, Dr. Robert Davis, MD, a professor of urology at the University of Rochester, N.Y. says that Khaw’s conclusions make perfect sense.  He further adds that his work has proved low testosterone to be common among men with metabolic syndrome – a group of mortality/death risk factors that includes abdominal fat, high blood sugar, low HDL cholesterol, high blood-fat concentrations, and high blood pressure.  Dr. Davis goes on to say that these finding are not surprising, and that the correlation between low testosterone metabolic syndrome is far more closely linked to common diseases such as heart disease, vascular disease, and diabetes.  According to Dr. Davis, more physicians should recognize the importance testosterone levels in people with metabolic syndrome, and should recommend that their patients receive routine checkups.

Other Health-Related Low Testosterone Conditions

Since low testosterone has been found to contribute to cardiovascular disease, and since men are testosterone-based beings, 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, and to point out further distinctions among male populations.

A variety of studies like the one conducted by CR Gale et al represents another subset of the male population, by bringing the factor of intelligence into view and asserting that it plays a role in the development of cardiovascular disease and early death.  In the July 2012 CR Gale of the MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK published a study in the Journal of Epidemiology Community Health entitled, ‘Intelligence in early adulthood and subclinical atherosclerosis in middle-aged men: the Vietnam Experience Study’.  The premise of this study was that people with a higher level of intelligence in early life possess a lower risk of coronary heart disease events.  Gale’s study aims were to investigate whether intelligence in early adulthood might be associated with risk of subclinical atherosclerosis in mid-life (as indicated by the ankle brachial index – ABI – a test used to predict the severity of arterial disease), and secondly to investigate its potential mediating role in the association between intelligence and mortality/death.  The study was comprised of a total of 4,286 male subjects all of whom were US veterans, and thus had intelligence measured at the mean age of 20.4 years during their military enlistment, and for whom ABI was again given at age 38 by Doppler during the scheduled follow up visit.  Additionally, researchers were able to adjust their measures to account for a variety of different variables such as body mass index, smoking, blood pressure, alcohol intake, education, serum cholesterol, triglyceride and glucose levels, erythrocyte sedimentation rate, age, and socioeconomic position all of which had virtually no effect on the results.  Gale’s results demonstrated that higher intelligence in early adulthood was in fact linked to a higher ABI during mid-life, thus demonstrating that an increase in intelligence reduces the risk of heart disease and a shortened lifespan.

In addition to its capacity for shortening men’s lives, low testosterone levels have been correlated with a several quality of life diminishing symptoms.  These hypogonadic symptoms, which may very well serve as early predictors of potentially serious life shortening problems include adverse symptoms such as:  poor overall sleep quality, including the inability to get to, stay, and achieve latter (deeper and more satisfying) stages of sleep; reduced bone and muscle mass, along with diminished muscular strength; increased depression, anxiety, and irritability; an increased resistance to insulin; a reduction in sexual performance, libido or arousal, the inability to achieve and/or sustain rigid erections; increasing overall body fat and fatty deposits; diminished cognitive faculties such as concentration and focus, memory and recall, often described as brain fog, etc.  Testosterone replacement therapy (TRT) is being investigated as a treatment in the more serious life threatening condition, and has already been proven highly successful in remedying a variety of mild and moderate symptoms as evidenced by the studies below:

• ES Andrade Jr., et al published a study in November of 2009 in the Arquivos Brasileiros de Endocrinologia e Metabologia entitled, ‘Short term testosterone replacement therapy improves libido and body composition’.  Andrade’s aim was to investigate the safety and efficacy of TRT within adult men who were experiencing late-onset hypogonadism.  Their findings demonstrated a significant difference after only eight weeks between the experimental and control groups. More specifically, the experimental group experienced greater sexual potency improvement, greater libido improvement, and greater decrease in waist circumference.

• In November of 2012 XW Zhang, et al of the Department of Urology, Peking University People’s Hospital, Beijing, China published a study in the Chinese Medical Journal entitled, ‘Androgen replacement therapy improves psychological distress and health-related quality of life in late onset hypogonadism patients in Chinese population’.  Zhang and his colleagues found that testosterone replacement therapy significantly improved a variety of hypogonadic symptoms, which included psychological symptoms.

• In September 2003 R. Goldstat, et al of the Jean Hailes Foundation Research Unit, Clayton, Victoria, Australia published a study in the Journal of North American Menopause entitled, ’Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women’.  Goldstat’s study aim was to investigate the effects of testosterone replacement therapy on testosterone deficient women suffering from hypogonadism as evidenced by premenopausal physiological decline, which included depressed mood, libido, well-being, and sexual function.  Their findings demonstrated that TRT significantly improved each of these symptoms in premenopausal women.

• In June of 2006 the European Journal of Endocrinology published a study by D. Kapoor, et al of the Centre for Diabetes and Endocrinology, Barnsley NHS Foundation Trust Hospital, Gawber Road, Barnsley, UK entitled, ‘Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes’.  Kapoor’s aim was to examine the effect of TRT on insulin resistance and glycaemic control in hypogonadal men with type 2 diabetes.  The researchers found that testosterone replacement therapy was significantly responsible for both reducing insulin resistance, and improving glycaemic control in hypogonadal men with type 2 diabetes, and further discovered that men in the treatment group experienced marked improvements in visceral adiposity (loss of between organs body fat) and cholesterol levels.  Collectively these results represent an improvement in general health, and a reduced risk of a shortened life.

REFERENCE LIST

• Low Testosterone, Early Death?
• Higher Death Risk in Men With Lower Testosterone Levels
• Why do I need to register or sign in for WebMD to save?
• We will provide you with a dropdown of all your saved articles when you are registered and signed in. By Daniel J. DeNoon
• WebMD Health News Nov. 27, 2007
• 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.
• Khaw KT, Dowsett M, Folkerd E, Bingham S, Wareham N, Luben R, Welch A, Day N. Circulation. 2007 Dec 4;116(23):2694-701. Epub 2007 Nov 26.
• Intelligence in early adulthood and subclinical atherosclerosis in middle-aged men: the Vietnam Experience Study.
• Gale CR, Deary IJ, Fowkes FG, Batty GD.
• J Epidemiol Community Health. 2012 Jul;66(7):e13. doi: 10.1136/jech.2010.109835. Epub 2011 May 10.
• Genetic aspects of atrial fibrillation in coronary artery disease patients Tseluyko V, Yakovleva L, Vashakidze Z. Georgian Med News. 2013 Oct;(223):35-40. Russian.
• Beneficial and adverse effects of testosterone on the cardiovascular system in men.
• Ruige JB, Ouwens DM, Kaufman JM.
• J Clin Endocrinol Metab. 2013 Nov;98(11):4300-10. doi: 10.1210/jc.2013-1970. Epub 2013 Sep 24.
• Is the effect of testosterone on body composition modulated by the androgen receptor gene CAG repeat polymorphism in elderly men?
• Lapauw B, Goemaere S, Crabbe P, Kaufman JM, Ruige JB.
• Eur J Endocrinol. 2007 Mar;156(3):395-401.
• Endogenous testosterone and cardiovascular disease in healthy men: a meta-analysis.
• Ruige JB, Mahmoud AM, De Bacquer D, Kaufman JM.
• Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. johannes.ruige@ugent.be
• Heart. 2011 Jun;97(11):870-5. doi: 10.1136/hrt.2010.210757. Epub 2010 Dec 21.
• Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women.
• Goldstat R, Briganti E, Tran J, Wolfe R, Davis SR.
• The Journal of North American Menopause. 2003 Sep-Oct;10(5):390-8.
• Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes.
• Kapoor D, Goodwin E, Channer KS, Jones TH.
• Eur J Endocrinol. 2006 Jun;154(6):899-906.
• Short term testosterone replacement therapy improves libido and body composition.
• Andrade ES Jr, Clapauch R, Buksman S.
• Arq Bras Endocrinol Metabol. 2009 Nov;53(8):996-1004.
• Androgen replacement therapy improves psychological distress and health-related quality of life in late onset hypogonadism patients in Chinese population. Zhang XW, Liu ZH, Hu XW, Yuan YQ, Bai WJ, Wang XF, Shen H, Zhao YP. Chin Med J (Engl). 2012 Nov;125(21):3806-10.
• Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009.   [PDF-2M] National vital statistics reports. 2011;60(3).
• Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013 Jan 1;127(1):e6-e245. doi: 10.1161/CIR.0b013e31828124ad. Epub 2012 Dec 12. http://circ.ahajournals.org/content/127/1/e6.long
• Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123:933-44. Epub 2011 Jan 24.
• Heron M. Deaths: Leading causes for 2008.   [PDF-2.7M] National vital statistics reports. 2012;60(6).
• CDC. Disparities in Adult Awareness of Heart Attack Warning Signs and Symptoms—14 States, 2005. MMWR. 2008;57(7):175–179.
• Centers for Disease Control and Prevention. State Specific Mortality from Sudden Cardiac Death: United States, 1999. MMWR. 2002;51(6):123–126.
• CDC. Million Hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors. United States, 2011. MMWR2011;60(36):1248–51.