For many years, testosterone was commonly thought to be linked to an increased risk of heart disease and early death.
This belief stemmed from the observation that men, who have much higher testosterone levels than women, are at greater risk of heart attacks and tend to experience these attacks earlier in life.
However, new research now suggests that low levels of testosterone, a condition commonly known as “low T,” may be more hazardous for men than normal or high amounts.
A comprehensive review of nearly a dozen studies examining the connection between sex hormones and the risks of heart disease and death has shed new light on the dangers of low testosterone. Scientists found that low testosterone levels in men were associated with an increased risk of death from any cause, and very low testosterone was specifically linked to a higher risk of cardiovascular death.
“Testosterone has a range of actions in the body — for example, affecting muscle and fat mass, and bone density, so it is possible that low testosterone concentrations might contribute to the development of poorer health outcomes,” says Bu B. Yeap, PhD, an endocrinologist and professor of medicine at the University of Western Australia in Perth.
“It is also possible that lower testosterone concentrations identify men already at risk of poorer health,” he adds.
The analysis, published in the Annals of Internal Medicine, involved examining hormone level data from over 240,000 men aged 50 to 76, with at least five years of follow-up. Dr. Yeap and his collaborators 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 typically range between 300 and 1,000 ng/dL.
The study revealed that 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. For those with testosterone levels below 153 ng/dL, there was a steeper increase in the risk of heart disease-related death, with these men facing nearly a 60 percent higher risk compared with those in the high-normal range.
Bradley Anawalt, MD, a professor of medicine at the University of Washington School of Medicine in Seattle, noted that few men are likely 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,” says Dr. Anawalt, who was not involved in the study. He suggests that testosterone supplementation in most men with low T will likely not provide a life-extending benefit, nor is it likely to increase the risk of dying.
“A prevailing wisdom for decades has been that testosterone is the cause of increased strokes and heart attacks,” says Dr. Anawalt. “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.”
Medications for Low T: Implications and Concerns
The study also highlighted a secondary finding: very low levels of estradiol (a type of estrogen) increased the likelihood of death from any cause for men.
In an editorial response, Dr. Anawalt emphasized that this finding should be considered when prescribing aromatase inhibitors – medications that increase testosterone by preventing its natural conversion to estradiol.
Men with low T are often prescribed aromatase inhibitors such as anastrozole (Arimidex) or letrozole (Femara).
“Part of the benefit of testosterone in men is caused by its conversion to estradiol or estrogen,” says Dr. Anawalt. “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.”
Maintaining Healthy Sex Hormone Levels
Overall, Dr. Yeap stresses the need for more research to understand how testosterone influence health outcomes in men. He recommends that men follow basic healthy lifestyle behaviors to 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,” says Dr. Yeap.
The new findings challenge the long-held belief that testosterone is inherently linked to increased cardiovascular risk. Instead, they highlight the potential dangers of very low testosterone levels and underscore the importance of maintaining balanced hormone levels for overall health.
As research continues to evolve, it is crucial for men to stay informed and proactive about their health, particularly regarding hormone levels and their potential impacts on well-being.
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