Testosterone vs HDL & Heart Disease

In case you hadn't noticed the pattern, I typically spend the week reviewing a handful of recent articles.  Over the weekends, I answer questions posted online at www.avvo.com and more recently at www.healthtap.com.  I've gravitated towards these two mainly because they limit the folks who answer questions to licensed providers.  

Anyway, one of the topics that I answer quite frequently is in regard to testosterone and its replacement.  Obviously, there's quite a bit of controversy about this hormone, especially when it comes to prostate cancer.  But there's also a need for clarity regarding its impact on HDL & cardiovascular disease.  

That's why I wanted to point out a short editorial published recently in Clinical Lipidology.  It turns out the published data is rather confusing & contradictory.  Part of this is due to the difference between abuse and normal replacement as well as methodology employed.  Taken in excess, all sort of side effects are possible, one of which is heart disease and other thrombotic events.  This excess is commonly achieved via injections. But this doesn't mean that injections can't be used safely.  It just requires close monitoring and a willingness to adjust both dose & frequency of injections.  It's clear that transdermal products are less likely to lead to large peak:trough ratios while oral anabolic/androgenic steroids are rife with concern due to first-pass metabolism.

For my patients, I always counsel, prior to prescribing anything, that excess testosterone, however achieve, can lead to an increase in blood pressure, decrease in HDL (good cholesterol), and increase in blood viscosity (polycythemia), all of which increase the risk for clot formation, eg heart attack and/or stroke.  Adjusting the dosing regimen or switching methodology is the key, I believe, to safely replacing testosterone in hypogonadal men.

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