Testosterone & Cardiovascular Health

Dr. Abraham Morgentaler & Testosterone




Dr. Abraham Morgentaler

Assoc. Clinical Professor of Surgery, Harvard Medical School
Expertise: Men’s Health

We live in a culture that is highly sensitive to medical risk. So, it should come as no surprise that a new article recently published in the New England Journal of Medicine grabbed headlines for suggesting that testosterone may be dangerous to the heart.

Learn more about the benefits of testosterone and testosterone treatment.

In the study, based at Boston Medical Center, frail elderly men (the mean age was 74) with limited mobility were randomly selected to receive either testosterone gel or placebo gel. Researchers wanted to see if testosterone treatment could improve lower extremity strength and physical function. Indeed, they soon found that the testosterone treatment did in fact improve strength. But they also discovered a surprising correlation that caused them to halt the study early: More cardiovascular events (such as heart attack, stroke or cardiovascular death) were noted among men who received testosterone compared with those who received the placebo.

This sounds bad until you learn that men in the testosterone group entered the study with more pre-existing cardiovascular risk factors than those in the placebo group. For example, the testosterone group contained a higher percentage of men already being treated for hyperlipidemia and hypertension. Moreover, since previous studies never indicated that elevated testosterone levels contributed to cardiovascular disease, the men were not monitored directly for evidence of heart trouble. Instead, researchers learned of cardiovascular events by reviewing external medical records — certainly not the most rigorous method of determining whether or not a treatment causes a certain kind of problem. Finally, the cardiovascular events that were the subject of the article were varied, from stroke to edema to high blood pressure. Only two men, both in the testosterone group, suffered actual heart attacks.

For these reasons, the authors of the study cautioned readers that the differences between the two groups may well have been due to chance alone. To my mind, if you compare two groups, one of which has more risk factors for illness to start, it’s no surprise when the high-risk group demonstrates more problems later on. This is true with or without treatment.

Science demands that we give the results of all new studies their due consideration but it’s important to recognize both the historical context and the existing literature. For decades, doctors and scientists hypothesized that testosterone was bad for the heart. They based this hypothesis on the fact that men have more heart attacks than women, and on the fact that men have more testosterone than women. However, study after study failed to support this idea. In fact, men with low testosterone tend to have more atherosclerosis than men with higher testosterone. Men whose testosterone is lowered severely due to treatment for advanced prostate cancer wind up having more heart disease than men whose testosterone remains untouched. And treatment with testosterone has been shown to improve glucose control and reduce fat, both of which are believed to be beneficial in fighting cardiovascular disease.

Given all of this, I suspect the new results will turn out to be an aberration — hardly unusual in the scientific realm. The idea that testosterone treatment is risky for the heart just doesn’t fit with what we know. In fact, there are significant proven benefits to testosterone therapy, including improvement in sexual interest and performance, improved muscle mass and strength, increased energy and a heightened sense of well-being. It would be a shame if men and their physicians became fearful of such a beneficial treatment because of an isolated negative report of dubious merit.

*Dr. Abraham Morgentaler is Director, Men’s Health Boston and Associate Clinical Professor of Urology, Harvard Medical School. He is also the author of “Testosterone For Life” and “The Viagra Myth.”

TOPICS: heart disease, mens health, testosterone

Human Growth Hormone & Sports

When Dad’s the Drug Pusher

April 10, 2008 by Kathy McManus
When Dad’s the Drug Pusher

Human Growth Hormone Injections

Like most competitive athletes, in-line speed-skater Corey Gahan hoped fierce determination and hard training would give him the edge he needed to fulfill his dream of becoming the best in his sport.

But unlike most competitive athletes, Corey Gahan’s father insisted on supplying that winning edge, regularly injecting his son with steroids and human growth hormone, the same illegal substances at the heart of the ongoing major league baseball scandal. And unlike the pros, Corey started to receive the shots when he was just 13 years old.

In less than a year, Corey’s blood tests showed he had more than 20 times the normal testosterone level of an adult male. His father continued the shots. Corey says he felt “like I was doing something wrong.” But the teenager trusted his father.

By age 15, Corey was a national champion; at 16, a record-setter. On the rare occasions Corey lost, his father refused to speak to him. When he won, the paternal rewards included televisions, PlayStations, and an American Express gold card.

And then Corey failed a drug test. And another.

The United States Anti-Doping Agency suspended him for two years, and a criminal investigation was begun to determine who had supplied Corey with steroid shots. He was ordered to forfeit all the races he had won in the previous two years.

But the final shot was the one through Corey’s heart, when he did what he believed he had a responsibility to do. Having already lost his status as a sports champion, Corey Gahan lost his father, by turning him in to authorities.

James Gahan–Corey’s father–was sentenced to six years in federal prison. He is believed to be the first parent in the U.S. convicted of providing steroids to his child.

Tell us what you think–Was there any other way Corey Gahan could have done the right thing without implicating his father? Should the son share responsibility with the father?

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