Hormones and Reproductive Health

Hormones and Reproductive Health

Written by Michelle Violi, Pharm.D. – Women’s International Pharmacy

 

Couple expecting babyWhat would we do without the human reproductive system? True, we might have fewer hormonal ups and downs, but it wouldn’t be long before humans would no longer populate the earth. Let’s take a closer look at how this very important system works in both women and men.

The Female Reproductive System

A woman’s reproductive system is delicate and complex. In order for conception to occur, it is important for a woman’s hormones to be balanced and her organs and tissues healthy. Hormones such as estrogen and progesterone play leading roles; however, there are many other hormones that are important players in the intricate process that is the female reproductive system.

Immediately following menstruation, estrogen levels begin to rise, causing the lining of the uterus to thicken. At ovulation an egg is expelled from the ovary into the fallopian tube where it travels to the uterus. After ovulation occurs, progesterone is produced from the corpus luteum, which forms in the ovary from which the egg was released.

Progesterone causes the uterine lining to become secretory and ready for the egg to implant should fertilization occur. If fertilization occurs, the fertilized egg implants in the uterine lining. The corpus luteum continues to produce progesterone until the placenta takes over its production in the second trimester of pregnancy. If fertilization does not occur, the corpus luteum breaks down, estrogen and progesterone levels fall, menstruation occurs, and the cycle begins anew.

The Male Reproductive System

A man’s reproductive system is no less complex. The primary hormones involved in the functioning of the male reproductive system are follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone.

FSH and LH are produced by the pituitary gland located at the base of the brain. FSH is necessary for sperm production (spermatogenesis), and LH stimulates the production of testosterone, which is necessary to continue the process of spermatogenesis. Testosterone also is important in the development of male characteristics, including muscle mass and strength, fat distribution, bone mass, and sex drive.

Hormonal Effects on Fertility

Infertility issues are very complicated and have many possible causes, including hormone imbalances or deficiencies. The following are just a few ways hormones play a role in fertility.

Hypothyroidism, or low thyroid function, can affect fertility due to menstrual cycles without ovulation, insufficient progesterone levels following ovulation, increased prolactin levels, and sex hormone imbalances. In a study involving 394 infertile women, 23.9% had hypothyroidism. After treatment for hypothyroidism, 76.6% of infertile women conceived within 6 weeks to 1 year.

Luteal phase deficiency (LPD) is a condition of insufficient progesterone exposure to maintain a normal secretory endometrium and allow for normal embryo implantation and growth. Progesterone is used in patients who experience recurrent miscarriages due to LPD. In addition, studies have shown progesterone can reduce the rate of preterm birth in certain individuals.

Conclusion

The human reproductive system is delicate, complex, and affects the overall health of women and men. Hormones serve an important role in maintaining harmony and promoting fertility in this intricate system. Because of this, achieving hormonal balance is a crucial component to supporting reproductive and overall health.

  • Lessey BA, Young SL. Yen & Jaffe’s Reproductive Endocrinology. 7th ed. Amsterdam, The Netherlands: Elsevier; 2014. https://www-clinicalkey-com.ezproxy.library.wisc.edu/#!/content/book/3-s2.0-B978145572758200010X?scrollTo=%23hl0000927 Accessed July 3, 2017
  • https://my.clevelandclinic.org/health/articles/the-male-reproductive-system Accessed July 3, 2017
  • Liedman R, Hansson SR, Howe D, et al. Reproductive hormones in plasma over the menstrual cycle in primary dysmenorrhea compared with healthy subjects. Gynecol Endocrinol. 2008;24:508-513. Accessed April 11, 2017.
  • Hassan SS, Romero R, Vidyadhari D, et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol. 2011;38:18-31.
  • Barda G, Ben-Haroush A, Barkat J, et al. Effect of vaginal progesterone, administered to prevent preterm birth, on impedance to blood flow in fetal and uterine circulation. Ultrasound Obstet Gynecol. 2010;36:743-748.
  • Mesen TB, Young SL. Progesterone and the luteal phase. Obstet Gynecol Clin North Am. 2015;42(1):135-151.
  • Verma I, Sood R, Juneja S, et al. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012 Jan-Jun; 2(1):17-19.
Hormones and Reproductive Health2017-12-05T12:33:07+00:00

A New Organ Has Been Identified: The Human Microbiome

A New Organ Has Been Identified: The Human Microbiome

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

That’s right. It has been there all along, but we are just now getting around to noticing it. This organ weighs about three pounds and by weight, it is the largest organ in the human body. The organ is a collection of microbes or single celled organisms that live on and in your body. It has been named the human microbiome.

Our bodies are made up of about 10 trillion cells, but we host approximately 100 trillion microbe cells. To put a trillion in perspective, if we were to live for one trillion seconds, our life span would exceed 32,000 years. Based on the math, we are only 10% human!

It was surprising to the scientific community when the Human Genome Project was completely finished earlier than anyone predicted. It turns out that human beings only have about 20,000 genes. We have significantly fewer genes than rice or corn! However, we also carry and use two to twenty million genes from the vast number of microbes we host. If we compare the number of human genes to microbe genes rather than the number of human to microbe cells in our body, we are 99% microbe!

In an effort to identify the microbes living on and in the human body, the Human Microbiome Project was begun in 2008. It was a massive undertaking funded by the National Institute of Health (NIH) to the tune of 170 million dollars. More than 200 scientists worked on the project. The Human Microbiome Project continues to generate significant scientific findings to this day. Some examples include new technologies that sequence genes and computer programs which can handle vast amounts of data. These discoveries are opening up very exciting new areas of research.

Our human microbiome makes us more individually unique than our genetic composition. Genetically we are 99% identical to other human beings, but we only share about 10% with other human microbiomes. Even genetically identical twins do not share the same microbiome.

Since the time of Louis Pasteur, we have been operating on the “germ theory of disease.” This philosophy states that diseases are caused by microorganisms. One might assume that we are hapless victims of microbial assaults and to save ourselves we must use antiseptics or antibiotics to stem the attack. The latest findings of the Human Microbiome Project cause one to think twice about this assumption.

Normally, we live in harmony with these vast numbers of microbes. In fact, a healthy microbiome aids us in some essential life processes such as digestion, the integrity of our immune systems and even our behavior. However, many different things can cause changes in the composition of an individual’s microbiome. Diet, drugs, birth order, age, sexual partners and especially antibiotics are just a few examples. An altered or weakened human microbiome has been linked to diseases such as obesity, arthritis, autism, and depression.

The human microbiome also plays a role in hormone production and regulation in the body. For example, an organism called Clostridium scindens, which resides in the gastrointestinal tract, has been identified as capable of transforming cortisol type hormones to testosterone and other androgens. Surprisingly, our sex glands are not the only source of testosterone in our bodies! The genes of some bacteria in the gut are able to produce estrobolome, an enzyme which helps metabolize estrogens. A disordered microbiome in the digestive tract could be the underlying cause of estrogen dominance producing symptoms of infertility, PMS, heavy bleeding, cramps, polycystic ovary disease and more

Additionally, an overgrowth of yeast and related organisms in the microbiome has many documented effects on various hormones. Request a yeast information packet which contains a detailed chart of specific organisms and their impact on hormone balance.

Since so many different things can alter the microbiome, research is focusing on how to repair a damaged microbiome system. For example, scientists have found altering the microbiome normalizes the weight of obese mice. We have also seen amazing results with procedures called fecal transfers where the microbiome of a healthy person is essentially implanted into the body of a sick person.

We have long been using probiotics in the forms of specific cultures or in fermented foods. We also know about the use of substances which we call prebiotics such as inulin or fructo-oligosaccharides (FOS) that can nurture the growth of certain species of microbes. We are just now beginning to understand which species of microbes need to be re-established and how to reintroduce these specific strains with supplementation. For the consumer, the marketplace for probiotics can be confusing and frustrating. There may be very helpful probiotic strains available, but we still lack the knowledge of which probiotic strain we should choose for each particular condition.

While the science is still evolving, there is a lot we can do in the meantime. We can avoid the frivolous use of antibiotics and avoid eating antibiotic treated meats. We can carefully consider the need for certain medication before using them. Drugs like oral contraceptives may damage the microbiome. We can clean up our diet and avoid dairy, sugar and gluten which can adversely affect the microbiome. We can eat fermented foods like sauerkraut, kimchi, kombucha, and live culture yogurt daily. We can add probiotics and prebiotics to our daily regimen. Because the science has not caught up yet, try a variety of products to determine which might have the best effect for you. We are clearly entering an exciting new world of understanding how we, as human beings, interact with the invisible yet powerful world of microbes.

A New Organ Has Been Identified: The Human Microbiome2018-04-03T16:31:26+00:00

Book Review – Venus on Fire, Mars on Ice

Book Review – Venus on Fire, Mars on Ice: Hormonal Balance – The Key to Life, Love and Energy by John Gray, PhD

Written by Carol Peterson, RPh, CNP – Women’s International Pharmacy

In his book Men are From Mars, Women are From Venus, Dr. John Gray focused on the differences between men and women; in Venus on Fire, Mars on Ice he delves into why those differences occur. Dr. Gray explains that, not only do we need a balance of hormones for managing PMS, post-partum depression, menopause, and andropause, but hormone balance also has a great impact on our relationships. Specifically, coping mechanisms for stress affect our relationships, and hormones play a vital role in the different ways men and women use to deal with stress.

Cortisol

Due to unrelenting demands of life in the modern world, many men and women are constantly stressed. As a result, cortisol production–which is designed to reach peak levels when challenged with an emergency and then quickly drop down–stays at a high level. A chronic high level of cortisol may contribute to emotional instability (among other things), which can affect relationships.

When trying to reduce or deal with stress, men release testosterone and women release the pituitary hormone oxytocin. High cortisol levels may interfere with normal production of both testosterone and oxytocin, hampering both men and women from their attempts at stress reduction.

Testosterone and Oxytocin

When a man’s testosterone level is adequate, it allows him to react in urgent situations where he needs to focus keenly, step up, and solve a problem. In fact, solving problems may cause some men’s testosterone levels to actually rise, while simultaneously lowering stress hormones like cortisol.

While small amounts of testosterone will also help women feel good, too much will actually increase their stress levels. Higher testosterone levels in women might be useful for competition, such as in the workplace, but sustained high levels of testosterone take a toll. When women get home from work, their stress levels may rise as they face the pressures of all the things that need to be done.

In contrast with the use of procrastination to increase testosterone in men, planning ahead stimulates oxytocin release in women. For women, a release of oxytocin makes them feel safe and nurturing, feelings that in turn encourage oxytocin levels to rise further. On the other hand, oxytocin doesn’t help men deal with stress and can even bring their testosterone levels down.

Insulin and Serotonin

Other fundamental substances that play an important role in relationships include the hormones insulin and serotonin and their interaction with glucose (blood sugar). Every cell in the body needs a consistent supply of glucose to function, and insulin controls how it is utilized. The brain is particularly sensitive to fluctuations in blood sugar, altering our moods, decision-making abilities, and other aspects of behavior that can affect interpersonal relationships.

When blood sugar drops, the production of serotonin (which has a calming effect) also drops. To make matters worse, the body responds to the low serotonin levels by producing more cortisol, which increases anxiety.

Conclusion

Dr. Gray believes that understanding these basic hormonal differences in each other is the key to maintaining loving relationships. Aging leads to lower levels of testosterone and oxytocin, as well as increased insulin resistance and low serotonin levels. This creates even more difficulty in dealing with stress, and makes hormonal balance even more critical. Dr. Gray suggests that diet and lifestyle are important building blocks to producing and maintaining these hormones in proper balance.

Book Review – Venus on Fire, Mars on Ice2018-07-10T17:41:01+00:00

Can Testosterone Protect Against Breast Cancer?

Can Testosterone Protect Against Breast Cancer?

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

 

Compounded testosterone therapy for women has been prescribed for years in this country. Since testosterone can convert to estrogen in the body, practitioners are sometimes hesitant to prescribe it, thinking that testosterone might increase a woman’s chance of getting breast cancer.

Dr. Rebecca Glaser and her colleague Constantine Dimitrakakis set out to examine this assumption. They designed the Testosterone Implant Breast Cancer Prevention Study to explore the relationship between testosterone subcutaneous implants and breast cancer. This study looked at 1,268 pre- and postmenopausal women who received either testosterone or testosterone-anastrozole (an estrogen blocker) implants. These same women were not using systemic estrogen therapy.

While the time period for this study is ten years, an analysis conducted at the five-year mark reported a breast cancer rate that was less than 50% of the rate reported in previous menopausal hormone replacement therapy studies. Study participants who most closely adhered to the testosterone regimen experienced an even lower rate of breast cancer. According to the National Cancer Institute’s surveillance program, more than twice as many cases of breast cancer would be expected in this particular study population if no specific interventions were made.

Dr. Glaser believes that these interim study results support her theory that testosterone use does not increase the occurrence of breast cancer. Further studies are warranted. Different dosage forms, as well as the possibility that testosterone therapy might protect against breast cancer, should be studied.

Can Testosterone Protect Against Breast Cancer?2018-04-03T17:20:42+00:00

Testosterone in Women

Testosterone in Women – A Commentary

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

 

Professor Susan Davis is a women’s health researcher. In 2005 she became the inaugural Chair of Women’s Health in the Monash University Department of Medicine at the Alfred Hospital in Melbourne, Australia. In addition, she is a consultant endocrinologist at Alfred Health and Cabrini Medical Centre, also in Melbourne.

Professor Davis has been involved in the study of the role of estrogens and androgens (e.g., testosterone and DHEA) in women. She has been investigating the effects of hormones throughout the body, rather than just how they affect reproductive functions. She has published over 300 peer-reviewed articles. She is indeed a giant in the world of research involving the use of testosterone in women.

In December of 1999, Dr. Davis published a commentary on the nature of testosterone replenishment in women. Almost 20 years has passed since this commentary was published, yet not much seems to have changed. Scientists and physicians are still unclear on what actually constitutes a deficiency of testosterone in women. The clinical picture of a woman with adequate testosterone has not been established or agreed upon. There is no agreement on how low testosterone levels must be before action is taken.

The following is a brief synopsis of a number of subjects taken from Dr. Davis’s commentary.

Declining Testosterone

It is well established that testosterone and DHEA production steadily declines with aging. There are also a number other reasons testosterone levels may be low:

  • 50% of testosterone production is lost when the ovaries are removed (oophorectomy) as part of a “complete hysterectomy.”
  • Chemical damage to the ovaries produced by chemotherapy in cancer treatments.
  • The use of estrogen only hormone therapies and oral contraceptives. Both increase sex hormone binding globulin (SHBG), which binds testosterone and prevents the body from using it.
  • Treatment with corticosteroid drugs like prednisone turns off the production of adrenal testosterone. This may be the cause of osteoporosis when using these drugs. It has been established that the best bone mineral density levels are associated with strong levels of testosterone and DHEA.
  • Premature ovarian failure.
  • Loss of cycling due to lost signaling from the hypothalamus.

Sexuality

It has been established that adequate testosterone levels are associated with sexual interest in a way that estrogen levels are not. However, because sexuality is complicated and multi-faceted, using libido and sexual activity as distinct markers for adequate testosterone levels is not reliable. One should also consider vaginal atrophy, pain during intercourse (dyspareunia), loss of interest in a partner, or other psychological factors as contributors to sexual dysfunction.

Bone Loss

Bone loss may continue to occur even with estrogen and progesterone supplementation. When testosterone supplementation is added, bone growth may be restored. Some suggest that testosterone acts as a prohormone for estrogens and that this interplay must be in effect for good bone health.

Body composition

In general, muscle mass declines in the elderly and fat mass increases. Testosterone has been demonstrated to improve muscle mass in postmenopausal women. Additionally, testosterone has been effective in restoring muscle mass in both immune compromised men and women.

Autoimmune disease

Women are more prone to autoimmune diseases. It has been theorized that the higher testosterone levels enjoyed by men contribute to this gender difference. Testosterone replacement has been used successfully in diseases such as autoimmune rheumatoid arthritis.

Premenstrual Syndrome (PMS)

Below average levels of circulating testosterone have been identified throughout the entire menstrual cycle in some women who have PMS symptoms. In Australia and the UK, testosterone has been used for treatment of PMS.

Forward to 2015

In 2015, Dr. Davis published another review article. She added cognition, cardiovascular health, and vaginal integrity, including pain relief to her documentation. She cites numerous studies about the anti-proliferative effect of testosterone in breast and ovarian cancer, but points out it is difficult to draw conclusions without considering the effects of multiple other hormones, including estrogens. In spite of testosterone being a much more prevalent hormone than even estrogen in women, we still don’t know much about its effects. Dr. Davis says that research in women lags about ten years behind where it should be. Too many studies are small and limited in their scope, making solid conclusions impossible.

In Closing

In spite of several attempts to obtain FDA approval for gels and patches delivering testosterone replenishment for women, nothing has been approved. This appears to be due to a lack of consensus on the function of testosterone in women. However, testosterone has been available to women for decades with the assistance of compounding pharmacists. Testosterone can be prescribed in oral capsules, creams, gels, suppositories, drops, troches, pellet implants, and injectables. Thanks to compounding pharmacies, practitioners may choose to treat each of their patients’ testosterone deficiencies and monitor the effects — one patient at a time.

  • Davis SR. Androgen Replacement in Women: A Commentary. J Clin Endocrinol Metab. 1999; 84(6): 1886-91.
  • Davis SR. Testosterone in Women: the Clinical Significance. Lancet Diabetes Endocrinol. 2015 Dec;3(12):980-92. doi: 10.1016/S2213-8587(15)00284-3. Epub 2015 Sep 7.
Testosterone in Women2017-12-14T15:41:59+00:00

A New Treatment Program to Improve Memory Loss

A New Treatment Program to Improve Memory Loss

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

In spite of hundreds of clinical trials over the past ten years, Alzheimer’s disease (AD) has no effective treatment. AD affects 5.4 million Americans, predominately females. It is estimated that women have a greater chance of developing AD than breast cancer.

Research supports the theory that an imbalance in brain nerve cell signals causes this disorder. Specific signals make nerve connections to cement memories while others allow irrelevant memories to be lost. This signaling system becomes imbalanced so that new memory connections are inhibited while more information is forgotten. Reversible metabolic processes may be involved in the early stages of AD.

Dr. Bredeson and his colleagues at UCLA believe that a comprehensive, personalized approach is the best way to treat memory loss. They have developed a program that optimizes diet (no simple carbohydrates, gluten, or processed foods), utilizes meditation and yoga, and emphasizes the importance of sleep, hormones, good oral health, and exercise. Patients may use supplements as well as medium chain triglycerides like coconut oil or Axona.

The researchers believe that free T3 and T4, estradiol, testosterone, progesterone, pregnenolone, and cortisol need to be optimized. Nine out of ten patients in this pilot program had cognitive improvement.

Additional Resources:

For more resources from Women’s International Pharmacy, see our Mental Health Resources page.

A New Treatment Program to Improve Memory Loss2018-04-04T15:44:16+00:00

Testosterone and Heart Disease

Testosterone and Heart Disease

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Evidence continues to mount that there is no scientific basis for the assumption that testosterone supplementation causes heart problems. The European Medicines Agency (EMA) recently reviewed the risk of serious cardiac problems in men using testosterone replacement.

EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) looked at major heart problems, particularly heart attacks. PRAC reviewed all recent negative studies plus data from positive studies and available safety data. They concluded that there is “no consistent evidence of an increased risk of heart problems with testosterone medicines.” PRAC also noted that there is evidence that low testosterone can increase the danger of heart problems.

This position has been adopted by the European Union. The EMA does support the conservative position that only men who are low in testosterone should receive replacement. They recommend periodic monitoring of hemoglobin, hematocrit, liver function and cholesterol. They caution that men with severe heart, kidney, or liver disease avoid testosterone altogether. Patients should talk to their doctor or pharmacist for further information.

Testosterone and Heart Disease2018-04-04T17:30:45+00:00

Sex Hormone Binding Globulin

Sex Hormone Binding Globulin

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

 

Hormone levels in the blood must be just right. Steroid hormones, including testosterone, estrogens, DHEA, and progesterone, among others, are fat-soluble, but our blood is mostly water. Therefore, hormones and the blood do not mix very well. The body’s solution to this problem is sex hormone binding globulin (SHBG), a protein created by the liver which connects with the fat-loving hormones. The resulting complex becomes water-soluble and can move freely in the blood stream, carrying these hormones throughout the body. It also acts as a reservoir for the hormones it carries and protects the hormones from hyperactive liver metabolism and kidney excretion.

Hormones combine with SHBG to different degrees of affinity or attraction. The most strongly bound hormone is dihydrotestosterone (DHT), the active form of testosterone, followed by testosterone itself.

Although to a considerably less degree than DHT and testosterone, SHBG also shows affinity for estrogens, DHEA, and even progesterone. Estrogens increase SHBG production in the liver if the liver is functioning correctly. Adiponectin, a hormone released by the fat cells, is also involved.

Hormones related to testosterone decrease SHBG production by the liver. Insulin, hypothyroidism, and liver disease may also decrease SHBG. Low levels of SHBG are predictive of metabolic syndrome, diabetes, sleep apnea, PCOS, kidney disease, and obesity.

A useful test for checking hormone levels involves collecting urine for 24 hours and measuring the amount of hormone leaving the body that day. If a patient has low SHBG levels, testosterone will come out in the urine in greater amounts and may be interpreted as the patient having plenty of testosterone when their level is actually low. In order to accurately interpret the urine test results, the urine test should be accompanied by a blood test to measure SHBG.

An interesting scenario happens when testosterone is used as a supplement. As mentioned previously, testosterone decreases SHBG production by the liver. With less SHBG available over time, the supplemental doses of testosterone are more rapidly excreted by the body and don’t have an opportunity to build up in the blood and get to the tissues. It is important to test for SHBG especially if testosterone supplementation does not appear to be working.

Low SHBG causing low testosterone availability puts one at risk for sleep apnea. Poor sleep can, in turn, cause a decrease in testosterone, SHBG, and growth hormone production, creating a viscous circle. Regaining weight after weight loss can be predicted by low SHBG, and Polycystic Ovary Syndrome (PCOS) is also characterized by low SHBG.

If SHBG levels are too high, both testosterone and estrogens are bound. High levels of SHBG increase one’s risk for osteoporosis because the testosterone and estrogens needed to assist with bone formation are not available for use. Birth control pills can increase SHBG greatly, and high SHBG can be predictive of blood clot formation while on these drugs. High SHBG can also be predictive for cardiovascular disease.

Understanding SHBG is another tool to use in evaluating hormones. We are often tempted to label functions in our bodies as “good” or “bad” and some might apply this thinking to SHBG levels. There isn’t good or bad SHBG, just the levels that provide the best functioning for our bodies.

  • Fogle S. SHBG: What is it good for? Presented at the Age Management Medicine Group meeting, Las Vegas, NV: 2014 November.
Sex Hormone Binding Globulin2018-04-04T17:28:24+00:00

Testosterone: A Possible Treatment for Dry Eye Syndrome

Testosterone: A Possible Treatment for Dry Eye Syndrome

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

An estimated 4- to 6-million older Americans suffer from mild to severe dry eyes. Dry eye syndrome (DES) has a wide variety of causes. This condition, while not life threatening, can be quite uncomfortable and distressing. (See our newsletter about Dry Eyes for more information.)

David Sullivan, a medical research scientist with the Schepens Eye Research Institute (a Harvard Medical School Affiliate), has spent the last 32 years studying the interrelationships between sex, sex steroids, and dry eye disease. His work has focused on the essential role that androgens play in the health and vital functioning of tear-producing glands.

Dr. Sullivan’s research suggests that testosterone deficiency contributes to tear instability and evaporation of the oil component of the tear layer. He supports the use of testosterone in the treatment of DES.

C.G. Connor studied the use of testosterone cream in DES. He found that testosterone cream, when applied to the eyelids, provided both symptom relief and an increase in overall tear production.
Additional Resources:
Testosterone: A Possible Treatment for Dry Eye Syndrome2017-12-13T16:44:00+00:00

Testosterone Replacement Therapy and Cardiovascular Disease

Testosterone Replacement Therapy and Cardiovascular Disease

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

There have been few medical debates more contentious than the current controversy surrounding testosterone replacement therapy (TRT) and cardiovascular disease (CVD).

Two recent studies highlighted a possible, though far from probable, association between TRT and myocardial infarction (MI) or stroke. However, the Androgen Study Group (ASG), which was formed to respond to inaccurate attacks on TRT by the medical and public media, quickly discovered misreporting that resulted in two published corrections to one of the studies. With support from medical societies, researchers, and scientists around the world, ASG petitioned the Journal of American Medical Association (JAMA) to retract one of the misleading studies.

Dr. Neal Rouzier, a geriatric specialist who routinely prescribes testosterone to his male patients, has also been vocal in his criticism of the JAMA study. He reports that none of the 2,000 male patients he has treated with TRT experienced MI, and he maintains that 40 years of radiologic and laboratory studies demonstrate long-term protection against plaque buildup. Although low levels of testosterone have consistently been associated with an increase in CVD and mortality, Dr. Rouzier supports a cautious approach when prescribing TRT in older men with CVD or significant risk factors.

A new study, presented at the 2013 meeting of the European Association for the Study of Diabetes, found that low testosterone levels are associated with an increased number of acute MIs in diabetic men. Another recently published study found that older men who received testosterone injections did not appear to have an increased risk for MI. In fact, testosterone injections actually appear to be protective in men at high risk for MI. Clinical data compiled from 40 Low T Centers nationwide also found no association between TRT and MI or stroke.

Testosterone Replacement Therapy and Cardiovascular Disease2018-04-03T11:01:06+00:00