Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. My name's Dr. Warrick Bishop and I'd like to welcome you to my podcast and videocast station and of course I'd like to welcome you to the Healthy Heart Network. Today I'd like to talk a little bit about testosterone, the male hormone. We've heard lots about estrogen and the women hormone over many years. Estrogen being looked at in lots of large studies trying to understand whether its role... in terms of supplementing estrogen levels for women who are postmenopausal, i.e. whose estrogen levels are dropping as they get older, whether that replacement is beneficial for those women or not. Well, I won't go into the details about the women's studies, but essentially the pendulum for the studies in females looking at estrogen swung from a bit of a problem to a good thing. to not sure and we're sort of now more in middle ground and the reality is that we now tend to look at this on a case-by-case basis understanding that the estrogen hormones may increase cardiovascular risk in certain situations but they also provide improved general well-being for people women who are having symptoms of lack of estrogen. We're not going to talk about estrogen today. We're going to talk about the male equivalent. As men are getting older, it's becoming more apparent that their hormone levels are dropping. Now, there's no surprise to that. And any male who's listening to this who's 50 odd years of age, a bit like I am, would recognize that your strength, your power... your recovery, your physical capacity just starts to gradually drop off slowly after about your mid to late 20s. Now that occurs slowly and we know it occurs pretty well in everyone. We know that your peak testosterone levels change through your life. Well there has been work asking the question if we replace testosterone in men who are aging, whose testosterone levels are dropping off, can we improve their strength? Can we improve their sex drive? Can we improve their recovery from injury? These questions are really quite interesting and seductive. It would be great to think that a hormone replacement therapy could be potentially a fountain of youth. Well, the studies that looked into that in the first instance really have cast a shadow on whether it is beneficial or not and certainly some work done right up until around about 2013 suggested that replacement of even physiological levels of testosterone in men whose testosterone levels had been dropping could increase cardiovascular mortality. Now Fortunately, some people have continued in that space to undertake research to inform our information even more. Fairly recently in the American Journal of Medicine, a trial was published that looked at about 15,000 men with low testosterone over approximately 12 years. More than half of those men received a topical application for their steroid their testosterone, steroid treatment and about a bit over a third received an injection for the administration of the hormone. What was interesting was in this study they again showed what appeared to be a slight increase in cardiovascular risk, that's heart attack, stroke and stroke-like episodes. However that wasn't a huge uptick. What was really noticeable, though, was that although there appeared to be an increased risk in cardiovascular events, overall mortality statistically was lowered in the men whose testosterone was replaced. What does this tell us? Well, it is a bit confusing. It's left us with a bit of a quandary. Interestingly, A researcher called Anna Walt, back in 2012, did some of that work, which initially demonstrated increased cardiovascular risk with testosterone. And when Anna Walt was asked to comment on this particular trial, they said that in their study, they had seen a similar trend, that there was an increase in cardiovascular events. But overall, A decrease in overall mortality. So, the explanation? We're not really sure. Certainly, if giving testosterone lowers overall mortality, at least that's a good starting point. Anna Walt was suggesting that that reduction in mortality overall may mean that the increase in cardiovascular risk is very small, but the benefit to the total body... greater through the role of testosterone things like strength things like avoiding falling over things like healing better being more mobile things that really improve not only quality of life but how you live and continue to function in your life really interesting space so testosterone therapy certainly still something that's going to be investigated, still something that is going to demand more information. Could it be that down the line we look at giving men testosterone replacement but try and offset the risk of cardiovascular event by cholesterol lowering medication and aspirin for example. Trying to negate or nullify the cardiovascular risk but still trying to maintain the improvement in strength, power, and as we would all hope, sex drive. I'm going to leave you with those entertaining thoughts. I hope I've shared with you something today that you find interesting. If you have any queries or questions, please let us know. If you have any ideas for any future podcasts, similarly, please let us know. As always, I wish you the very best. And of course, please don't die from a heart attack. Take care. And goodbye.
