Low levels of testosterone have been associated with increased body weight, insulin resistance (a precursor to diabetes and a risk factor for heart disease), and poor cholesterol levels. These metabolic factors ultimately lead to cardiovascular disease.
A noteworthy overview of androgen deprivation therapy and its tight link to cardiovascular disease has been published in the journal Circulation. In it, a group that included members of prominent heart, cancer and urological societies, issued a well-researched position stating that prostate cancer patients who are on androgen deprivation therapy (ADT) are at an elevated risk for getting heart disease.
Evidence shows that when one’s androgen levels are lowered, a metabolic syndrome ensues. This does not necessarily mean that patients should not be on ADT, but does pave the way to new screening strategies for metabolic syndrome for those on ADT.
Most importantly, this brings to light, again, the negative effect that low testosterone has on insulin sensitivity and the heart. Metabolic syndrome and cardiovascular disease can potentially be prevented via the optimization of testosterone levels.
For males, it is important to understand what your “total” and “free” testosterone levels are, and to perform a thorough workup that focuses of deciphering the cause of why the levels are low (or high) in the first place. Then, a treatment strategy should ensue. This should focus on addressing the cause, first and foremost. Thereafter, treating the cause is key.
There are many options for patients with low testosterone. Lifestyle changes should ensue as they are often significant contributors to low testosterone levels. Supplements and/or medication that can boost testosterone levels can also be judiciously utilized. There are also supplements and medications that can work on preventing the aromatization of testosterone (conversion of testosterone into estrogen in fatty tissue). Those patients on intentional ADT in the setting of prostate cancer cannot be on androgen replacement therapy.
- Zina Kroner, DO