How Testosterone Helps the Heart

As it is commonly reported in the media that steroids can cause your heart to blow a ventricle, kidneys to implode, and your liver to disintegrate. But is this actually true? Well in reality, the more you learn about steroids, the more you come to realize that, like all drugs, there is a difference between their intelligent use and outright abuse. So we will take a look at the effects of testosterone on the heart and see how these common conceptions hold up.

For ages now, we’ve all heard the repeated saying that anabolic steroids are bad for the heart. Some physicians will tell you that testosterone raises your risk of heart disease by lowering your good cholesterol and raising your bad cholesterol. It is also reported that steroids are known to induce an enlargement of the heart or even cardiac hypertrophy.

In reality, the dangers of steroids are overstated and may even be good for the heart.

What are the cardiovascular effects of steroids?

In a recent test, bodybuilders had various aspects of the heart measured such as the carotid intima-media thickness, arterial reactivity, left ventricular dimensions to name a few. These measurements indicate whether bodybuilding, steroid usage, or both affect the shape, function, activity and size of the heart.

The doctors found some obvious and not so obvious results. The bodybuilders who used steroids were physically stronger than those who didn’t and the use of steroids was not found to cause any significant changes or abnormalities of arterial structure or function.

In essence, when both groups of bodybuilders were compared with sedentary controls, any changes in heart function were common to both steroid-using and non-steroid-using bodybuilders. So all said and done, what we learn from this study is that bodybuilding itself can alter, not impair, arterial structure or function and steroids do not appear to impair cardiac function.

TRT heart 2Does MRFIT need a T boost?

The Multiple Risk Factor Intervention Trial (MRFIT) is a study that examined changes in testosterone over a 13 year period in 66 men aged 41 to 61 years. The researchers concluded that changes in total testosterone are related to cardiovascular disease risk factors.

The average testosterone levels at the beginning of the study were 751 ng/dl and decreased by 41 ng/dl. Also, men who smoked or exhibited Type A behavior were found to have even greater decreases in T levels. The change in testosterone was also associated with a decrease in in the good cholesterol and an increase in triglyceride levels.

The conclusion stated that decreases in testosterone levels as observed in men over time are associated with unfavorable heart disease risk.

In a similar study, researchers in Poland examined if testosterone replacement therapy in aging men positively affected heart disease risk factors. It noted that twenty-two men with low T levels received 200 mg of testosterone enanthate every other week for one year. Throughout this treatment, total cholesterol, testosterone, estradiol, LDL and HDL were measured. The researchers concluded that T replacement returned both testosterone and estradiol levels back to normal and normal levels. They also found that T replacement lowered cholesterol and LDL, which is the bad cholesterol without altering HDL, which is the good cholesterol and there was no change in prostate size or function.

This study proved that T replacement doesn’t appear to raise heart disease risk – and it may actually lower your risk. There are many physicians out there today that should be prescribing low dose testosterone to middle age and aging men for muscle tone, both libido and for cardiac reasons.

It’s been long shown and proved that men have a higher risk of heart disease. One of the risk factors implicated is testosterone. The recreational use of testosterone can alter lipoprotein levels and in many cases reports exist that describe bodybuilders who’ve abused steroids and have experienced heart disease or even sudden death. But one can still ask, is the causal association one of truth or just an association? Well, researchers at the University of North Texas recruited twelve competitive bodybuilders for a comprehensive evaluation of the cardiovascular effects of steroids. Six heavyweight steroid-using bodybuilders were compared with six heavyweight drug-free bodybuilders.

And sure enough the heavy steroid users had lower total cholesterol and HDL levels as compared to the drug-free athletes. What was unexpected was that the steroid users also had significantly lower LDL and triglyceride levels as compared to the non-steroid users. In addition, the juicers also had lower Apo-lipoprotein B levels, which is a marker for heart disease risk. Thus, the authors concluded that androgens do not appear to raise the risk of cardiovascular disease. Thus the conclusion of this study is that the negative cardiac side effects of steroids are most likely overstated.

We know that as we age, circulating testosterone levels naturally decrease. For most men, the testosterone decrease goes from high normal to mid to low normal. There is also data that shows that there’s an inverse relationship between T levels and blood pressure as well as abdominal.

Testosterone replacement lowers abdominal obesity and restores testosterone levels back to normal. Positive side effects of restored testosterone is correlated with stronger sex drive, better mood, lower cardiovascular, disease risks, better muscle tone, stronger bones and improved memory. It should also be noted that while conservative use gives a pronounced positive health benefit, higher doses might not necessarily lead to further health benefits.

Positive Effects of anabolic steroids on the Heart

Anabolic steroids will cause your kidneys to implode, your heart to blow a ventricle, and your liver to squirt out of your arse, fly across the room, and knock the cat off the futon. We read it on the Internet and saw an after school special about it, so it must be true, right?

Actually, the more you learn about anabolic steroids, the more you come to realize that, like all drugs, there’s a difference between their intelligent use and outright abuse. In this article, Doug Kalman takes a look at the effects of Testosterone on the heart. What he found may surprise you.

Over the years we’ve all heard the repeated mantra that anabolic steroids are bad for the heart. Some physicians will tell you that gear raises your risk of heart disease by lowering your good cholesterol (HDL) and raising your bad cholesterol (LDL). In fact, as some docs will tell you, anabolic steroids are known to even induce cardiac hypertrophy (enlargement of the heart). And since you can’t flex your heart in an effort to woo women, who’d want that?

But, as in every story, there’s more than one side. In fact, let it be said, the dangers of anabolic steroids are overstated and, hold onto your seats, may even be good for the heart. Let’s examine some of the scientific studies on the positive effects of Testosterone on the heart.

What are the cardiovascular effects of anabolic steroids?

Cardiologists at the Royal Prince Alfred Hospital in Australia recruited both juicing and non-juicing bodybuilders for a study. Each bodybuilder had various aspects of the heart measured (carotid intima-media thickness, arterial reactivity, left ventricular dimensions, etc.). These measurements indicate whether bodybuilding, steroid usage or both affect the function, size, shape and activity of the heart.

The doctors found some obvious and not so obvious results. Predictably, those bodybuilders who used steroids were physically stronger than those who didn’t. What was surprising was that the use of steroids was not found to cause any significant changes or abnormalities of arterial structure or function.

In essence, when the bodybuilders (both groups) were compared with sedentary controls, any changes in heart function were common to bodybuilders. The take home message from this study is that bodybuilding itself can alter (not impair) arterial structure/function and that steroids do not appear to impair cardiac function.

Does MRFIT need a T boost?

A famous cardiac study was published about 10 years ago. It soon became on ongoing study known as the Multiple Risk Factor Intervention Trial (MRFIT). The present study examined changes in Testosterone over 13 years in 66 men aged 41 to 61 years. The researchers determined if changes in total Testosterone are related to cardiovascular disease risk factors.

The average Testosterone levels at the beginning of the study were 751 ng/dl and decreased by 41 ng/dl. Men who smoked or exhibited Type A behavior were found to have even greater decreases in T levels. The change in Testosterone was also associated with an increase in triglyceride levels and a decrease in the good cholesterol (HDL).

The authors concluded that decreases in Testosterone levels as observed in men over time are associated with unfavorable heart disease risk. (2) Sounds to me like a good reason to get T support/replacement therapy in the middle age years!

In a similar study, researchers in Poland examined if Testosterone replacement therapy in aging men positively effected heart disease risk factors. Twenty-two men with low T levels received 200 mg of Testosterone enanthate every other week for one year. Throughout treatment, Testosterone, estradiol, total cholesterol, HDL and LDL were measured.

The researchers determined that T replacement returned both Testosterone and estradiol levels back to normal and acceptable levels. They also found that T replacement lowered cholesterol and LDL (the bad cholesterol) without altering HDL (the good cholesterol). Furthermore, there was no change in prostate function or size.

The take home message from this study is that T replacement doesn’t appear to raise heart disease risk and it may actually lower your risk. It appears that more physicians should be prescribing low dose Testosterone to middle age and aging men for both libido, muscle tone and for cardiac reasons.

What about younger men?

It’s been long established that men have a higher risk of heart disease. One of the risk factors implicated is Testosterone. Reportedly, the recreational use of Testosterone can alter lipoprotein levels and, in fact, case reports exist describing bodybuilders who’ve abused steroids and have experienced heart disease or even sudden death. But the question remains, is the causal association one of truth or just an association?

To answer this, researchers at the University of North Texas recruited twelve competitive bodybuilders for a comprehensive evaluation of the cardiovascular effects of steroids. Six heavyweight steroid-using bodybuilders were compared with six heavyweight drug-free bodybuilders.

As expected, the heavy steroid users had lower total cholesterol and HDL levels as compared to the drug-free athletes. What was unexpected was that the steroid users also had significantly lower LDL (the bad cholesterol) and triglyceride levels as compared to the non-steroid users. In addition, the juicers also had lower apolipoprotein B levels (a marker for heart disease risk). Thus, the authors concluded that androgens do not appear to raise the risk of cardiovascular disease. The take home message from this study is that the negative cardiac side effects of steroids are most likely overstated.

In a little more progressive study, researchers at the Albert Einstein College of Medicine in the Boogie Down Bronx (the BDB to those in the know) examined Testosterone as a possible therapy for cardiovascular disease. The researchers note that T can be given in oral, injectable, pellet and transdermal delivery forms. It’s noted that injections of Testosterone (100 to 200 mg every two weeks) in men with low levels of T will decrease total cholesterol and LDL while raising the HDL.

In fact, Testosterone therapy has been found to have antianginal effects (reduces chest pain). Low levels of Testosterone are also correlated with high blood pressure, specifically high systolic pressure. The researchers determined that returning T levels back to normal and even high-normal levels have positive cardiovascular effects and should be considered as an adjunctive treatment for maintaining muscle mass when someone has congestive heart failure.

Putting it all together

Strong research demonstrates that the risks of negative cardiovascular effects of steroids are overstated. In fact, a recent paper published in the Canadian Journal of Applied Physiology questioned the whole risk of using steroids. (6) Joey Antonio, Ph.D. and Chris Street MS, CSCS published strong data showing that the risks of steroid use are largely exaggerated, much like scare tactics used by your parents while you were a kid. Of course, it goes unsaid that abuse of anything will lead to unwanted consequences.

We know that as we age, circulating Testosterone levels naturally decrease. For most people the Testosterone decrease goes from high-normal to mid to low normal. Data shows that there’s an inverse relationship between T levels and blood pressure as well as abdominal obesity (that paunch we see on so many middle age males).

Testosterone replacement lowers abdominal obesity and restores Testosterone back to normal levels. Restored Testosterone is correlated with better mood, better muscle tone, stronger sex drive, lower cardiovascular disease risks, stronger bones and better memory. It’s important to note that while conservative use gives a pronounced positive health benefit, higher doses may not necessarily lead to further health benefits.

What to do

If you see your body composition changing (your gut starts looking like your Uncle Lester’s), your strength or muscle tone diminishing despite your hard training and good diet, and your sex drive not matching up to TC’s columns, have your Testosterone levels checked. The acceptable normal range for Testosterone to physicians is 300 mg/dl to 1100 mg/dl. Yes, that’s a pretty wide range.

In the clinic, we see people with the complaints consistent with “andropause” (a term for male menopause) and/or increased cardiovascular risk having Testosterone levels between 300 mg/dl and 550 mg/dl. Bringing it up to the mid to high-normal level is what gives the health and “youthful” benefits. Traditionally 200 mg/dl of supplemental Testosterone given every one to two weeks improves body composition, lowers total cholesterol and LDL, while raising HDL.

It appears that supplemental T is a healthier and safer way to go than many of the drugs used to treat poor lipid profiles. The data presented in this article applies for males over 35, not those who are 18. If you think that you can benefit from Testosterone therapy look for physicians who market themselves as “anti-aging” or “longevity physicians” as well as the more progressive endocrinologists or cardiologists.

Erectile Dysfunction.Tadalafil (Cialis)

Tadalafil (Cialis) is the third oral medicine approved by the U.S. FDA for the treatment of erectile dysfunction. Like sildenafil (Viagra) and vardenafil (Levitra), tadalafil inhibits PDE5 (as described earlier).

How effective is Tadalafil (Cialis)?

The safety and efficacy of Tadalafil in the treatment of erectile dysfunction was evaluated in 22 clinical trials involving more than 4,000 men. Seven of these trials were randomized, prospective, placebo-controlled studies of 12 weeks' duration. Two of these studies (involving 402 men) were conducted in the United States, and the other five studies (involving 1,112 men) were conducted outside the United States. Two of these trials were conducted in special populations with erectile dysfunction; one in men with diabetes mellitus, another in men who developed erectile dysfunction after nerve-sparing prostate cancer surgery.

Effectiveness of Tadalafil in these studies was assessed using a sexual function questionnaire. Study participants also were asked if they were able to achieve vaginal penetration and to maintain erections long enough for successful intercourse.

In all seven trials, Tadalafil was significantly better than placebo in improving men's ability to achieve and maintain erections. Improvements in erectile function was observed in some patients at 30 minutes after taking a dose; and improvements can last for up to 36 hours after taking Cialis when compared to placebo.

How should Tadalafil (Cialis) be administered?

The recommended starting dose of Tadalafil for most patients is 10 mg taken orally approximately one hour before sexual activity. The dose may be adjusted higher to 20 mg or lower to 5 mg depending on efficacy and tolerability. The maximum recommended dosing frequency is once per day, although for many patients Tadalafil can be taken less frequently since the improvement in erectile function may last 36 hours. Tadalafil may be taken with or without food. Tadalafil is also available in 2.5 mg. or 5 mg. dosages for daily use

What are the side effects of Tadalafil (Cialis)?

Tadalafil is generally well tolerated with only mild side effects.

The most common side effects reported include:

• headache
• indigestion 
• back pain 
• muscle aches 
• facial flushing
• nasal congestion.

Back pain and muscle aches occurred in less than 7% of patients and usually occurred 12-24 hours after taking Tadalafil. The back pain and muscle aches associated with Tadalafil were characterized by mild to moderate muscle discomfort in the lower back, buttocks, and thighs, often aggravated by lying down. The back and muscle aches resolved in most patients without treatment within 48 hours. When treatment was necessary, acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin, Advil, or Aleve were effective. Approximately 0.5% of all the patients using tadalafil discontinued the drug due to back pain or muscle aches.

Reports of abnormal vision were rare; it occurred in less than 0.1% of patients using Tadalafil.

There have been rare reports of priapism (prolonged and painful erections lasting more than six hours) with the use of oral PDE5 inhibitors such as vardenafil, sildenafil, and tadalafil. Men with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Untreated priapism can cause injury to the penile tissue and lead to permanent loss of potency. If there is prolonged erection (longer than four hours), immediate medical assistance should be sought.

Who should not use Tadalafil (Cialis)?

Tadalafil can cause hypotension (abnormally low blood pressure, which can lead to fainting and even shock) when given to patients who are taking nitrates. Patients taking nitrates daily should not take tadalafil. Most commonly used nitrates are medications to relieve angina (chest pain due to insufficient blood supply to heart muscle because of narrowing of the coronary arteries). These include nitroglycerine tablets, patches, ointments, sprays, pastes, and isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate are found in some recreational drugs called "poppers."

Tadalafil should not be used with alpha-blockers, medicines used to treat high blood pressure and benign prostate hypertrophy (BPH) because the combination of Tadalafil and an alpha-blocker may lower the blood pressure greatly and lead to dizziness and fainting.

Tadalafil is not recommended for men with the following conditions:

• unstable angina (chest pain due to coronary artery disease that occurs at rest or with minimal physical exertion),
• low blood pressure (a resting systolic blood pressure less than 90mm Hg),
• uncontrolled high blood pressure (greater than 170/110 mm Hg),
• recent stroke or heart attack (within six months),
• uncontrolled, potentially life-threatening abnormal heart rhythms,
• severe liver disease,
• severe heart failure or disease of the heart valves, for example, aortic stenosis,
• retinitis pigmentosa.

Therefore, men with these conditions should not use Tadalafil without having these conditions evaluated and stabilized first. For example, men with uncontrolled high blood pressure should have their blood pressure controlled; and men with potentially life-threatening abnormal heart rhythms should have these rhythms controlled.

When there is angina or heart failure, the doctor may need to determine whether the heart has enough reserve to safely carry out the work necessary for sexual activity by performing cardiac treadmill stress testing.

What precautions should be taken when using Tadalafil?

In most healthy men, some of the drug will remain in the body for more than two days after a single dose of Tadalafil. Metabolism (clearing of the drug from the body) of tadalafil can be slowed by liver disease, kidney disease, and concurrent use of certain medications (such as erythromycin, ketoconazole, and protease inhibitors). Slowed breakdown allows Tadalafil to stay in the body longer and potentially increase the risk for side effects. Therefore, the dose and frequency of tadalafil has to be lowered in the following examples:

Men with severe liver disease should not take Tadalafil. Men with mild to moderate liver disease should not exceed Tadalafil dose of 10 mg once daily.

Body weight heavily influenced by gut microbes: Genes shape body weight by affecting gut microbes

Our genetic makeup influences whether we are fat or thin by shaping which types of microbes thrive in our body, according to a new study. Scientists identified a specific, little known bacterial family that is highly heritable and more common in individuals with low body weight. This microbe also protected against weight gain when transplanted into mice. The results could pave the way for personalized probiotic therapies that are optimized to reduce the risk of obesity-related diseases based on an individual's genetic make-up.

By studying pairs of twins at King's Department of Twin Research, researchers identified a specific, little known bacterial family that is highly heritable and more common in individuals with low body weight. This microbe also protected against weight gain when transplanted into mice.

The results could pave the way for personalised probiotic therapies that are optimised to reduce the risk of obesity-related diseases based on an individual's genetic make-up.

Previous research has linked both genetic variation and the composition of gut microbes to metabolic disease and obesity. Despite these shared effects, the relationship between human genetic variation and the diversity of gut microbes was presumed to be negligible.

In the study, funded by National Institutes of Health (NIH), researchers sequenced the genes of microbes found in more than 1,000 fecal samples from 416 pairs of twins. The abundances of specific types of microbes were found to be more similar in identical twins, who share 100 per cent of their genes, than in non-identical twins, who share on average only half of the genes that vary between people. These findings demonstrate that genes influence the composition of gut microbes.

The type of bacteria whose abundance was most heavily influenced by host genetics was a recently identified family called 'Christensenellaceae'. Members of this health-promoting bacterial family were more abundant in individuals with a low body weight than in obese individuals. Moreover, mice that were treated with this microbe gained less weight than untreated mice, suggesting that increasing the amounts of this microbe may help to prevent or reduce obesity.

Professor Tim Spector, Head of the Department of Twin Research and Genetic Epidemiology at King's College London, said: 'Our findings show that specific groups of microbes living in our gut could be protective against obesity -- and that their abundance is influenced by our genes. The human microbiome represents an exciting new target for dietary changes and treatments aimed at combating obesity.

'Twins have been incredibly valuable in uncovering these links -- but we now want to promote the use of microbiome testing more widely in the UK through the British Gut Project. This is a crowd-sourcing experiment that allows anyone with an interest in their diet and health to have their personal microbes tested genetically using a simple postal kit and a small donation via our website (www.britishgut.org). We want thousands to join up so we can continue to make major discoveries about the links between our gut and our health.'

Ruth Ley, Associate Professor at Cornell University in the United States, said: 'Up until now, variation in the abundances of gut microbes has been explained by diet, the environment, lifestyle, and health. This is the first study to firmly establish that certain types of gut microbes are heritable -- that their variation across a population is in part due to host genotype variation, not just environmental influences. These results will also help us find new predictors of disease and aid prevention.'