LE Magazine May 2003
Improve Your Sex Life And
Protect Against Heart Attack
By J. Phillip Vogel
Did you know that testosterone deficiency predisposes men to heart disease, depression and a host of other ailments associated with normal aging?
The problem is that most doctors are ignorant of the fact that cells throughout the body require testosterone to properly function. Insufficient testosterone causes males to lose strength, virility, cognitive function and their youthful health. The long-term consequence of testosterone deficiency is possible death from a wide range of diseases.
Testosterone remains a misunderstood hormone to all but the most dedicated health enthusiasts. The general public is afraid of testosterone because some young athletes have abused it. Others think it causes prostate cancer. Scientific studies, on the other hand, clearly show that lack of testosterone is an underlying culprit behind many age-related disorders.
Today's physicians practice medicine as if low testosterone has no impact on an aging man's health. For example, if a male patient is depressed, anti-depressant drugs are prescribed that often fail to correct the underlying problem. Anti-depressant drugs have many unpleasant side effects including impotence, which can make a man feel even more depressed. Published studies document that testosterone replacement is an effective anti-depressant in many men.
Men who complain of impotence are routinely prescribed Viagra®, a drug with both unpleasant and potentially lethal side effects. Testosterone can be far more effective than Viagra because it stimulates sexual receptor sites in the genitalia and the brain1 (where it enhances desire).
When testosterone levels are low, the body tries to compensate by making more cholesterol, a precursor to adrenal testosterone production. Many men prescribed statin drugs can obtain the same cholesterol-lowering effect by restoring their testosterone level to a more youthful range.2
The most profound effect that testosterone has in the body may be its ability to prevent atherosclerosis and heart attack. A series of new studies reveal that testosterone is a critical missing link that cardiologists are failing to account for in treating those with coronary artery disease and congestive heart failure.3 This article discusses the beneficial functions of testosterone and describes methods for safely restoring levels to healthy ranges.
In youth, testosterone levels are at their peak. Vitality, assertiveness, and libido all thrive in their hormone-induced glory. As we age, however, the endogenous level of this essential androgen begins to drop drastically. By the time a man is 30 years old, he will have already started down the path of testosterone deficiency, losing as much as 2% every year for the rest of his life.4 This means that by the time he reaches 60 years of age, he will be functioning with about 60% less testosterone than he had in his twenties.
It is now estimated that as many as 40 million men in the U.S. suffer from inadequate levels of testosterone-and most of them don't even know it.5 They only know that they are depressed, or that their sex drive is not what it used to be. But a lowered sex drive is not the biggest problem associated with testosterone deficiency.
Recent research has revealed that testosterone, long thought to be a causative factor in heart disease, actually prevents many forms of this killer.6 In fact, at youthful levels testosterone can keep diseases such as atherosclerosis at bay almost indefinitely.7 With this revelation comes a whole new problem: How do you re-establish youthful levels of testosterone?
Testosterone: What is it?
Historically speaking, testosterone has been the subject of much speculation and scrutiny. Long before scientists knew what testosterone was or where it came from, ancient cultures were carving statues depicting testicles as the symbols of fertility and virility. As of 1400 AD, the Chinese were regularly processing urine from young men and mixing it with ground bull testicles to produce an extract used for treating impotence, prostate enlargement and infertility.8
|Figure 1. Metabolic Pathways Involved with Testosterone. Testosterone is synthesized from cholesterol by means of a number of enzymatic reactions. The immediate precursors of testosterone are androstenedione and DHEA-Sulfate (DHEA-S). Both testosterone and androstenedione can undergo metabolic conversion to estrogens (estradiol and estrone) via the aromatase enzyme.|
Today, we have a much greater understanding of the production and purpose of testosterone. We now know, for example, that testosterone is the major androgen hormone produced in males; that it is created predominantly by the Leydig cells in the testes in response to the release of luteinizing hormone (LH) by the pituitary gland. We also know that it is carried by the bloodstream and binds to specific target cells where it exerts tissue-dependent effects, such as masculinization, anabolism (tissue building) and sexual arousal. Testosterone is a major growth hormone that stimulates the production of red blood cells within the bone marrow.9 Testosterone also inhibits cells called osteoclasts that enhance bone breakdown. When testosterone deficiency occurs, as with aging and in other conditions, a lack of inhibition of these very same cells stimulates bone loss that leads ultimately to osteoporosis.10
But despite our seemingly vast knowledge on the subject, much of the value of testosterone has yet to be elucidated. Researchers are just now discovering that not only does testosterone affect us sexually, but that it is also responsible for numerous biological actions including protein synthesis, oxygen uptake, cholesterol regulation and immune surveillance.11
Of these new discoveries, one of the most controversial-and potentially life saving-is testosterone's beneficial effect on the cardiovascular system.
The myth of testosterone
Diseases of the heart and blood vessels have become a nationwide epidemic, killing more than half a million men in the U.S. every year.12 While it's commonly known that the chances of developing heart disease grows proportionally with age, the fact that the increased risk may be tied to the progressive reduction of available testosterone has not yet been universally accepted by conventional medicine.
Owing to early studies that showed men to be twice as likely to die from coronary heart disease than women, it has long been believed that physiologically high levels of testosterone has a deleterious effect on the cardiovascular system. This theory has further been supported by cases of sudden cardiac death and other cardiovascular disorders that have been induced by the abuse of anabolic steroid drugs such as methyltestosterone.13
Another complication was that for many years, endocrinologists failed to believe that testosterone levels dropped in relation to age. Older patients with heart disease were tested and their testosterone levels found to be within the youthful range. Unfortunately, scientists were looking for the wrong type of testosterone measuring the total amount of testosterone rather than focusing on the free testosterone.
THE DANGERS OF
Most of the hesitation to use natural testosterone supplements or creams to prevent cardiovascular disease stems from the popular misconception that all testosterone is the same. It isn't.
Whereas most studies on natural testosterone have shown positive physiological effects, anabolic steroid drugs are another matter entirely. While synthetic testosterone steroids may resemble the natural testosterone molecule, they are in fact chemically different and do not provide the same healthful benefits. On the contrary, anabolic steroids such as methyltestosterone have numerous serious side effects that actually lay the foundation for heart attack and stroke-such as increased LDL cholesterol*and blood clotting-the very problems that natural testosterone combat.**
* Zitzmann M, et al. Contraceptive steroids influence the hemostatic activation state in healthy men. J Androl 2002 Jul-Aug;23(4):503-11.
** Mottram DR, et al. Anabolic steroids. Baillieres Best Pract Res Clin Endocrinol Metab 2000 Mar;14(1):55-69.
We now know that much of an aging man's testosterone is "tied up" or bound to a protein called sex hormone-binding globulin (SHBG). Once bound to SHBG, testosterone is no longer available for use by the rest of the body, becoming in effect biologically inert. As a result, the typical male has only a small amount of bio-available or "free" testosterone accessible-roughly about four percent of the total testosterone. Furthermore, research has shown that this free testosterone becomes increasingly bound with age, leaving available levels of testosterone low while total levels appear normal.14
But despite having to overcome the hurdles of medical dogma that erroneously devalued testosterone for decades, researchers have finally established an indisputable link between its youthful levels and a healthy cardiovascular system.
To lay the groundwork for our examination of these cardiovascular benefits, we'll begin with a brief discussion of the cardiac disease most often induced by low levels of testosterone: atherosclerosis.
The foundation of heart disease
Atherosclerosis is the most common form of cardiovascular disease. It is the accumulation of fatty plaque deposits in the arteries, resulting in stenosis-a narrowing of the arterial diameter, which restricts blood flow to vital organs.15
Depending on the location of the stenosis, atherosclerosis can manifest itself in several different ways. Should the blockage occur in one or more of the arteries that supply the heart, coronary artery disease (CAD) results. The most common clinical manifestation of CAD is angina pectoris (chest pain). This occurs when the oxygen needs of the heart muscle are inadequate. In essence, the heart muscle is crying out for more oxygen. Angina, therefore, is symptomatic of narrowed coronary arteries and their inability to allow proper blood flow to suit the heart's need during physical exertion or emotional stress. If blockage of coronary flow is complete, it will result in a heart attack (myocardial infarction or MI).16
If the blockage appears in the arteries supplying the brain, the result is called a cerebrovascular accident or stroke.17 Restricted blood flow to the legs-known as claudication-interferes with the ability to walk, resulting in pain and disability due to a lack of oxygen caused by the impaired blood flow. When such stenosis becomes severe, infection and gangrene may follow, often leading to amputation of the afflicted limb.18
To treat these disorders, common medical practice relies on various techniques such as angioplasty and coronary artery bypass grafts.19 Angina is most often treated with medication such as nitroglycerin which rapidly dilates the coronary arteries allowing more blood to flow to the malnourished heart.20 The effects of nitroglycerin do not last long.
Although these procedures are often effective at temporarily keeping the disease manageable, preventing atherosclerosis in the first place is by far the best solution. To do this, you need testosterone.
Continued on Page 2 of 4
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