Dr. Kathy Maupin and Brett Newcomb discuss concerns being brought to light as a result of recent studies by the US Veterans’ Hospital that asks the question, “Does Testosterone Replacement Cause Heart Attacks in men?”
One of my patients recently presented me with a question about whether or not replacing testosterone could cause heart attacks and strokes in men. He had heard about a study that was done at Veterans’ Hospital which concluded that there was an increased risk of stroke or heart attack associated with this type of treatment.
This week’s podcast is a discussion about my patient’s question. Hopefully, it will help reassure our listeners about the safety of replacing testosterone in men in general, as well as educate them about how to consider or evaluate “scientific” studies as they are presented in the mass media. One of the frustrations that I have is that people consume mass media from a perspective of the headlines. They tend to read and absorb the short, succinct message of a headline without digging into more detail in the article. There is also a well-documented tendency to believe things you see in the press. I would strongly encourage you to take more care in reaching conclusions about health care based on media representations of limited studies.
Let’s look at the issues of the study that my patient was talking about. The study made conclusions based on a very limited population of men who were over 65 and were veterans who had already had a stroke or a heart attack and who were receiving treatment for other issues. This is a very limited sample which has significant restrictions that differentiate them from men in the general population.
There are thousands of research studies that have been done among a broader population of men that consistently demonstrate that replacing testosterone does not increase your chance of having a heart attack or a stroke. Testosterone replaces muscle strength. The heart is a muscle. A stronger heart muscle means you are less likely to have a stroke or heart attack. Testosterone reduces cholesterol which means that your arteries are not as clogged and blood flow is improved both in the brain and in the body. Testosterone reduces inflammation throughout the body. Inflammation causes arteries to be “sticky” and to collect cholesterol and create plaque, narrowing vessels and decreasing blood flow to the heart and brain. Plaque also causes weakness of all blood vessels causing ruptures and aneurisms. Testosterone replacement decreases inflammation and plaque and, in many studies, it has been proven to decrease the risk of heart attack and stroke. As you can see, there are many benefits that decrease risk and improve overall heart strength and health.
There are market forces that cause the writing of articles about studies such as this one to go viral. Lawyers will advertise for clients for potential legal challenges. People who sell products will use these limited results to bolster their market claims. One of the ways that both of these things happen is through confusing causation and correlation. For example, if two things happen at around the same time, they are correlated. It does not automatically mean that one event caused the other, it just means that there are overlaps which should be considered. Patients should be careful of drawing conclusions when they are really dealing with correlations. Causation is the definite linkage between one event and an outcome based on finding the mechanism of how that happens.
This study ignores the link between testosterone replacement and the outcome they claim.
A second reminder about making decisions regarding your health care is that it is necessary to be compliant with the instructions your doctor gives you for following a health protocol, and many studies do not require compliance. In regards to your own care you can only expect the optimal outcome if your follow your doctor’s instructions. You need to rest and get a good night’s sleep, you need to exercise, reduce smoking, reduce alcohol consumption, eat well, etc. Your physician should provide you with a list of behaviors that improve your global health along with the specific treatment for the specific illness you may have.
Watch this week’s informative podcast to help yourself become an informed consumer of medical information.