• There’s been a recent concern about testosterone and heart disease. A study published in the New England Journal of Medicine in 2010 found an increased risk of heart disease in men over the age of 65 while taking testosterone, and a study published in PLOS One in 2014 found an increased risk of heart disease in men under the age of 65 while taking testosterone. These findings were unexpected and run counter to the decades of research and hundreds of studies published on testosterone showing it to be beneficial to the cardiovascular system. So why the disparity now? Why were the results from these two recent studies so different from previous studies? There are 3 reasons for this:

    1. Excess Red Blood Cells: In some men, testosterone can stimulate the bone marrow to produce more red blood cells. While this is desirable for someone who is anemic, it is not desirable for someone possessing risk factors for heart disease including high cholesterol, high blood pressure, diabetes, smoking, excess weight, physical inactivity, and family history of early heart disease. Too many red blood cells—a condition known as erythrocytosis—can make the blood too viscous (thick) and potentially cause it to clump together and clot. Blood viscosity is measured by a routine lab test called hematocrit. Hematocrit measures the percentage of the volume of whole blood that is made up of red blood cells. Reference ranges vary slightly among laboratories, but in general, the full range is 40-54%. The optimal range, however, is 40-45%. Irrespective of testosterone therapy, because most of us have sedentary (desk) jobs, to help prevent blood clots, it is wise to keep one’s blood on the “thinner” side (lower end of hematocrit reference range) rather than on the “thicker” side (higher end of hematocrit reference range).

    Unfortunately, in neither of the two studies cited above was hematocrit ever measured. At More T Clinics, we measure hematocrit before and after starting testosterone therapy. This is part of the ongoing monitoring of treatment we provide. The cost for this is covered in our all-inclusive, flat monthly fee. Our goal is to keep your hematocrit level in the optimal range of 40-45%. If it is found be to be above 45%, donating a pint of blood at your local blood bank will lower hematocrit safely and effectively.

    2. Excess Estrogen: Testosterone therapy can increase a man’s level of estrogen. Women synthesize estrogen in their ovaries. Since we lack this part of the female anatomy, we produce needed estrogen through a process involving an enzyme called aromatase that converts a small portion of our testosterone to estrogen. Optimal levels of estrogen have numerous health-promoting benefits, however, excess estrogen has been linked to an increased risk of heart disease (not to mention prostate disease). Reference ranges for estrogen (estradiol) vary slightly among laboratories, but in general, the full range is 15-60 pg/mL. The optimal range, however, is 15-25 pg/mL.

    Unfortunately, in neither of the two studies cited about was estrogen ever measured. At More T Clinics, we measure estrogen before and after starting testosterone therapy. This too is part of the ongoing monitoring of treatment we provide. Our goal is to maintain your estrogen level in the optimal range of 15-25 pg/mL. To accomplish this, we utilize a safe and effective, twice-weekly, estrogen-blocking medication called Anastrozole. Anastrozole partially blocks the aromatase enzyme and prevents over-conversion of testosterone to estrogen. The cost of Anastrozole is covered in our all-inclusive, flat monthly fee.

    3. Excess Testosterone: In the two studies cited above, the treatment of choice was topically applied testosterone. It is assumed that when testosterone is delivered to the body topically, only 10% of it is absorbed. It is also assumed that when testosterone is delivered to the body topically, the standard venous blood test accurately reflects how much testosterone is getting to the tissues throughout the body. Under these assumptions, the FDA has approved daily dosages of topical testosterone that are 10 times higher (50-100 mg) than the daily amount healthy young men produce in their testicles (5-10 mg). Unfortunately, both of these assumptions are wrong and are causing millions of men to overdose from topical testosterone. This is because topical testosterone is transported primarily by the lymphatic system and not the circulatory system. Most doctors prescribing testosterone do not know this.

    Short of a direct determination via tissue biopsy, the way to indirectly determine the tissue level of testosterone is to measure the level in capillary blood from a specialized finger-prick test. Capillary blood is representative of the amount of testosterone at the tissue level whereas venous blood is not. This is because venous blood measures the amount of testosterone being carried away from the tissues, and capillary blood measures the amount of testosterone being carried toward the tissues. In healthy young men, the level of testosterone in the venous blood is equal to the level of testosterone in the capillary blood. However, most doctors would be shocked if they knew that, in their patients using topical testosterone, the level of testosterone in the capillary blood exceeds that of venous blood by as much as 10-20 times! At these extreme levels, testosterone itself may increase the risk of heart disease.

    It is important to note that the excess (overdose) amount of testosterone at the capillary (tissue) level described above is NOT seen when using injections, pellets, or pills. In these other treatment modalities, the level of testosterone in the venous blood is equal to the level of testosterone in the capillary blood. At More T Clinics, we never use topical testosterone. Because of the numerous advantages outlined in our website, we utilize subcutaneous microinjections to reverse testosterone deficiency.

    In conclusion, a healthy level of testosterone can greatly improve your quality of life. However, when done incorrectly, testosterone therapy can turn from friend to foe. At More T Clinics, we have the right credentials and the right expertise to help make testosterone therapy safe and immensely beneficial.