Stroke, Heart Attack, and Testosterone

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Dr. Kathy Maupin and Brett Newcomb talk about a recent ad campaign for a class action lawsuit agains a particular brand of testosterone replacement treatment. They discuss the misleading studies that have contributed to the misconception that strokes and heart attacks are caused by testosterone treatment.

Lawyers all over the United States are advertising for customers who have suffered from a stroke or heart attack while taking prescribed testosterone. They are trying to gather enough male patients so that they can file a class-action lawsuit against the manufacturer of the particular testosterone supplement. These lawyers are not primarily concerned about patient care. Their efforts are business-driven, and highlight the law’s power to generate money for lawyers. They hide their ulterior motives, claiming to stand up for the little guy. However, the fact is that class-action suits make significantly more money for the lawyers than for the patients who are involved. And if that weren’t enough, their commercials—which may not be based on facts—attempt to scare men who might be considering testosterone treatment that might dramatically improve the quality of their lives, as well as help prevent other illnesses of aging.  This invades the subconscious of potential patients who then refuse to consider this treatment. If all that they have heard about this treatment is the allegations levied against them, they are unlikely to pursue it as an avenue.

There is no widely-accepted medical research that has been validated that proves that testosterone replacement causes strokes and heart attacks. In fact, the opposite is true. Data from studies looking at testosterone and heart attack and stroke that reveals that low testosterone—not high testosterone—is the more probable cause. No matter what the facts are, one inaccurate study is all it takes to set the legal-eagles spinning into a frenzy. The result is hundreds of hours of commercials about the risks of testosterone replacement.

My friend, Brett Newcomb and I regularly monitor the research on these topics and others so that we can address our patients’ and viewers’ concerns. This week, we are discussing an article from a recent edition of the Journal of Endocrinology entitled “Beneficial and Adverse Effects of Testosterone on the Cardiovascular System of Men.”

Before we get directly into the substance of the article, we review a little about the importance of the topic and discuss some of the other research that we have covered on this topic in previous podcasts. In particular, we reflect on the research of Dr Abraham Morganthaler of Harvard University.

As we discuss this article, Brett highlights his concerns about the specific medical terminology that is used in this field. We talk about how to translate those medical terms into common English so that most people can understand the claim that is being made or the point that is being addressed. The main point of the article is that there is plenty of evidence that has been gathered over years of research (1970-2014) supporting the fact that low amounts of testosterone are connected to cardiovascular events in men.

The article covers the research on this topic and identifies many of the reasons for this. It suggests that perhaps the low amount of testosterone is causative: highlighting the physiologic steps in the path between low testosterone to plaque development and then heart attack and stroke. We tend to agree and I point out the ways in which testosterone can prevent the deterioration that leads to cardiovascular disease and even death.

Additionally, we discuss the questions that exist due to the lack of consensus on what a “normal” or healthy level of testosterone is for men. Testosterone is replaced, according to the article, at what doctors believe are “normal “ levels. In my work, I have found that the definition of normal is not agreed upon in medicine.  Normal can mean “average” for the group tested, or average for your age, but the normal we should be talking about in testosterone is the “optimal” level of testosterone that brings men back to health.  For men to be truly healthy, they need a restoration of the optimal, healthy levels they had between age 20-40.  When doctors try to achieve the average for age, then they are under dosing.  We should also be looking at the level of Free Testosterone and not just total T. Free Testosterone levels drop off with age and it takes a higher total to achieve the young, healthy level of T in aging men. One cause of the decrease of Free T is the tendency of testosterone to convert into more estrogen as they age, and estrogen can cause heart disease.  Increasing T and lowering estradiol and estrone can protect against that.  That is exactly what I do with my male patients.

Please listen to our podcast if you or anyone you care about has been diagnosed as at-risk for cardio events such as a stroke or heart attack. There is something that can be done to prevent the problem and to improve the health and survivability of  men.