Melvin A. Martinez-Castrillon, MD

Hormones and the heart

      The data about hormonal therapy and cardiovascular health continues to mount. It seems incredible, but we have known of the protective effects of hormonal replacement and hormonal optimization and your heart for at least 25years. Despite this, this key missing ingredient continues to be underutilized in our cardiovascular patients. It is therefore the reason we diagnosed and treat hormonal imbalances to further protect and keep our cardiovascular patients safe and free from further cardiovascular events. 

     What hormones are we talking about? Below you will find  multiple references regarding what we know about testosterone and thyroid as well as estrogen and their protective effects on the cardiovascular system and how it clearly translates into demonstrable mortality benefits and reductions in cardiovascular events and complications. It turns out that among the many body systems that benefit from optimal testosterone, thyroid and estrogen levels, the heart and the brain are likely two of the most benefited.  Keeping our hormonal levels as close to when we were in our 30's and NOT letting  them dwindle downwards with all its inherent pathology and symptoms seems to be the beneficial way to go. The data lately (over three major investigational studies in the past 36 months) demonstrates how even during acute events when having a stroke (CVA) or heart attack (MI), optimizing therapy with testosterone and thyroid hormones, particularly T3, seems to be massively protective and all associated to better outcomes, including repeat events and mortality. It seems therefore clear to us that we must no longer ignore this and treat our patients accordingly. 

     Testosterone (T) has a number of important effects on the cardiovascular system. In men, T levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk. Low T levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes. Reduced T levels in men with congestive heart failure (CHF) portends a poor prognosis and is associated with increased mortality. Studies have reported a reduced CV risk with higher endogenous T concentration, improvement of known CV risk factors with T therapy, and reduced mortality in T-deficient men who underwent T replacement therapy versus untreated men. Testosterone replacement therapy (TRT) has been shown to improve myocardial ischemia in men with CAD, improve exercise capacity in patients with CHF, and improve serum glucose levels, HbA1c, and insulin resistance in men with diabetes and prediabetes. 

  • Testosterone replacement therapy has been shown to:

    • ○ improve myocardial ischemia in men with CAD

    • ○ improve exercise capacity in men with CHF

    • ○ improve serum glucose levels, HbA1c, and insulin resistance in men with diabetes and prediabetes

     

     Male or female? Well, it seems both are benefited and protected when hormonal balance is optimized. Particularly in males the story of testosterone seems quite clear. In women Estrogen seems to play that protective role more so than testosterone.