Although aging is often seen as a badge of honor, consultant cardiologists caution that men may face a decline in testosterone levels as they age, which can have a detrimental impact on their cardiovascular well-being.

This decline in testosterone is recognized as a potential risk factor for heart disease and mortality, highlighting the importance of monitoring and managing testosterone levels to promote overall health and reduce the risk of cardiovascular issues.

Their observations stem from a recent study published in the Annals of Internal Medicine on May 14, 2024, linking low testosterone levels in men to mortality from cardiovascular diseases. The study, conducted by Bu Yeap and colleagues, aimed to clarify the debated stance on how circulating sex hormones influence mortality and cardiovascular disease risk in aging males.

Titled ‘Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men: Individual Participant Data Meta-analyses,’ the study found that men with low testosterone levels, high luteinising hormone, or extremely low estradiol concentrations faced an elevated risk of all-cause mortality.

In analyzing the data, the study considered various independent variables, including testosterone, Sex Hormone–Binding Globulin, luteinising hormone, dihydrotestosterone, and estradiol concentrations. Primary outcomes such as all-cause mortality, cardiovascular disease-related deaths, and incidents of cardiovascular disease were recorded.

Factors that may influence the study’s results were identified as age, body mass index, marital status, alcohol consumption, smoking habits, physical activity levels, hypertension, diabetes, creatinine concentration, ratio of total to high-density lipoprotein cholesterol, and the use of lipid-lowering medications.

The authors found, “The association of lower testosterone concentrations with higher all-cause mortality was present irrespective of luteinising hormone concentrations, indicating that low testosterone was the main factor.”

The Lead researcher, Bu Yeap, said men with lower testosterone concentrations and normal or high SHBG had increased mortality risk, but those with lower testosterone concentrations and low SHBG had lower mortality risk.

“This is consistent with the fact that men can have lower testosterone concentrations in the presence of low SHBG, without being hypogonadal,” he added.

At the Houston Methodist, U.S., Dr Khurram Nasir Confirmed the study, stating, “Testosterone deficiency has an unfavourable effect on cardiovascular health. It can even be considered a risk factor for heart disease.”

The cardiologist highlighted that this research has significant implications for the approximately one-third of men between 40 and 80 years old who experience low testosterone, a condition influenced by various lifestyle factors and health conditions, such as being overweight and having type 2 diabetes.

He explained that testosterone levels naturally decline by about 1-2% annually after age 30, but some men may experience a more rapid decline, leading to early-onset testosterone deficiency.

While common symptoms of low testosterone include decreased libido, fatigue, and muscle loss, the connection between low testosterone and heart health is more intricate, according to Dr. Nasir.

He stated, “Based on what we know about the association between testosterone deficiency and metabolic issues, impaired glucose metabolism, poor cholesterol levels, and inflammation, all of which are linked to heart disease, we can infer that testosterone deficiency is also associated with poor heart health.”

The Preventive Cardiologist pointed out that a prominent indicator of this issue is erectile dysfunction, which is the most frequently reported sexual concern among men aged 40 and above when they visit their doctor.

This highlights a common and significant aspect of men’s health that is often linked to testosterone levels and cardiovascular well-being.

“ED is often the result of poor blood circulation caused by atherosclerosis when the arteries that supply the body with blood become narrowed due to plaque buildup leading to High Blood Pressure. This link might be indirect, but it’s why ED can be a warning sign of heart disease,” Nasir noted.

A Professor of Cardiovascular Medicine with the University of Abuja, Augustine Odili, emphasized the importance of Nigerians being aware of their Blood Pressure status to decrease cardiovascular deaths in the country .

Augustine Odili, who is also the National President of the Nigerian Cardiac Society, said that knowing one’s blood pressure status can help reduce deaths by 50% in Nigeria. He noted that blood pressure is a condition that can be easily diagnosed, but if neglected, can lead to irreversible outcomes.

Augustine Odili also mentioned that 80 to 90% of deaths are cardiovascular-related, which is a major source of stroke and the major cause of heart failure, kidney failure, and erectile dysfunction, among others.

“An increased risk of premature cardiovascular events in men initially led to the belief that testosterone had detrimental effects on cardiovascular health. Some large observational and randomised studies have supported this conclusion, whereas others have suggested a cardioprotective role for testosterone.

“With testosterone therapies being used in the treatment of conditions that affect millions of men worldwide, the relationship of testosterone to cardiovascular risk and disease must be better understood to inform guidelines for use of these therapies.”