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By Sola Ogundipe

Testosterone, the key male sex hormone, is vital for various bodily functions. Produced in the testicles, it helps regulate many aspects of the body, including men’s bone mass, muscle mass, and libido.

It’s produced primarily in the testicles and is essential for the production of sperm and red blood cells.

Testosterone also helps with: Fat distribution, Facial and body hair, and a sense of well-being.

Now, a study found that men with low testosterone levels had a higher risk of death from all causes and heart disease. However, the study also suggests that normal testosterone levels may not be a major factor in why men are more prone to heart attacks too and strokes than women.

Testosterone levels and heart disease have long been a topic of debate. While testosterone was previously thought to be linked to an increased risk of heart issues, recent research suggests the opposite may be true. Studies now show that low testosterone, or “low T,” may be more hazardous for men’s hearts than normal or high levels.

In a review of nearly a dozen studies that examined how sex hormones were connected to the risks of heart disease and death, scientists found that low testosterone in men was associated with increased risk for death from any cause, and that very low testosterone was linked with a higher risk of cardiovascular death in particular.

Endocrinologist Bu B. Yeap suggests low testosterone may contribute to health problems or indicate underlying health risks. Testosterone impacts muscle, fat, and bone density, and low levels could be a risk factor or a consequence of other health issues.

For the analysis, published in the Annals of Internal Medicine,  Yeap and his team looked at data measuring hormone levels in over 24,000 men between the ages of 50 and 76. Participants had at least five years of follow-up.[2]

The team determined that men with testosterone concentrations below 213 ng/dL (nanograms per deciliter) had a gradual increase in the likelihood of death from any cause. Normal testosterone levels in men are between 300 and 1,000 ng/dL. The men with the lowest testosterone concentrations had about a 40 percent higher risk of death from any cause compared with men with testosterone levels in the high-normal range.

Below 153 ng/dL there was a slightly steeper increase in risk of heart disease-related death, such that men with the lowest testosterone levels had a nearly 60 percent higher risk compared with men with testosterone levels in the high-normal range.

With the lower end of normal at 300, Bradley Anawalt, MD, a professor of medicine at the University of Washington School of Medicine in Seattle, notes that few men are going to reach these very low concentrations where the risk of early death becomes significantly higher.

“For men who do have low levels of testosterone, they’re often going to be just a little low. A prevailing wisdom for decades has been that testosterone is the cause of increased strokes and heart attacks.

These findings suggest that having either a baseline normal blood testosterone or testosterone therapy that raises blood testosterone into the normal range will not increase the risk of major adverse cardiac events,” says  Anawalt, who was not involved in the study.

He suggests that any testosterone supplementation in most men with low T will most likely not provide a life-extending benefit, but unlikely to raise the risk of dying.

A secondary study found that very low estradiol levels were linked to an increased risk of death in men. This is important because aromatase inhibitors, which are medications used to treat low testosterone in men, also reduce estradiol levels.

“Part of the benefit of testosterone in men is caused by its conversion to estradiol or estrogen. These results indicate that taking medications to block this conversion is not a good idea.

“Men need normal amounts of estrogen for good health. If you don’t have enough estrogen, a man’s body fat goes up and bone density and bone strength go down, ” Anawalt stated.

Overall, Yeap stresses that more research is needed to understand how testosterone influences health outcomes in men.

He recommends following some basic healthy lifestyle behaviours to help maintain proper hormonal balance, such as eating a healthy diet and exercising regularly.

“Men should be encouraged to take greater interest in their own health. And they should have health checks, and seek medical attention if symptoms, such as low sex drive and erectile dysfunction may be present.”