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New research finds that men with low testosterone may be at a higher risk of cardiovascular disease and death. Hirurg/Getty Images
  • A study has found that low testosterone in men was linked with a higher risk of dying.
  • Those with very low testosterone have a higher risk of dying from CVD.
  • This might be because low testosterone is associated with certain CVD risk factors.
  • Low testosterone can be detected with a simple blood test.
  • Treatment may involve lifestyle changes or hormone replacement therapy.

While the sex hormone testosterone tends to be most associated in people’s minds with the development of male characteristics and a healthy desire for sex in both men and women, it plays other roles related to muscle size and bone strength.

It is also thought to play a part in mood and might be involved in ovarian function in women.

Scientists believe this important chemical messenger probably also has other functions that are yet to be discovered.

In fact, a new systematic review and meta-analysis published online on May 13, 2024, in Annals of Internal Medicine reports that having low levels of testosterone might affect men’s risk for cardiovascular disease (CVD) as well as their risk for death.

Specifically, those with low baseline serum testosterone had an increased risk of dying from any cause.

Those with very low baseline levels additionally had an increased risk of dying from CVD.

Prior to the study, there had been controversy surrounding the question of whether using testosterone therapy to return low testosterone to normal levels could increase CVD and all-cause death risk in men.

The study authors wanted to learn if low testosterone itself was putting men at risk for these health outcomes.

The University of Western Australia researchers, along with other Australian researchers as well as researchers from Europe and North America, gathered 11 studies, including 24,000 people, to see how testosterone might influence the risk of death in older men.

The men from the selected studies had previously had their total testosterone measured using mass spectrometry. They also had been followed for a minimum of five years.

The researchers were able to gather data about baseline levels of various hormones, including total testosterone, sex hormone-binding globulin, luteinizing hormone, dihydrotestosterone, and estradiol.

They then looked for any relationships between these levels and people’s relative risk for cardiovascular events, cardiovascular deaths, or deaths from any cause.

After their analysis, they determined that men with low total testosterone (below 7.4 nmol/L [213 ng/dL]) had a greater risk of dying from any cause.

Further, those with very low levels of testosterone (below 5.3 nmol/L [153 ng/dL]) had a higher risk of dying from cardiovascular disease.

Karen Eilber, MD, a urologist and co-author of “A Woman’s Guide to Her Pelvic Floor: What the F*@# is Going On Down There,” who was not involved in the study, confirmed the association that was found between testosterone and death risk.

“What isn’t clear,” she added, “is whether testosterone levels directly contribute to death from these causes or low testosterone is just a sign of overall poor health.”

The study authors suggest that one reason low testosterone might be associated with worse health is the fact that lower testosterone leads to people having less muscle mass and greater fat accumulation, which are both risk factors for cardiovascular disease.

Low testosterone might also be associated with other accompanying health problems, leading to a greater risk of dying.

S. Adam Ramin, MD, a board certified urologist, urologic oncologist, and medical director of Urology Cancer Specialists in Los Angeles, California, who was also not a part of the study, noted several possible health issues that could be associated with low testosterone.

“It is true that low testosterone will lead to lower sexual desire and possibly difficulty with erections,” he said. “However, low testosterone is also associated with many systemic medical problems.”

According to Ramin, these include loss of bone density, loss of muscle mass, weight gain, moodiness, fatigue, and depression.

“Furthermore, low testosterone may lead to heart attacks, strokes, and death,” he said.

Eilber explained that learning whether you have low testosterone requires only a simple blood test.

However, she noted that if you have a low total testosterone, the test might not be as accurate.

“The testosterone level should be drawn mid-morning,” advised Eilber. This is when testosterone is at its peak for the day.

It’s also important to recognize that there are two types of testosterone numbers that will be on your report: total and free.

“[F]ree’ testosterone is the form that is bio-available,” Eilber explained. Being bio-available means that it can be easily put to use in your body.

Total testosterone measures both free testosterone and that which is bound to certain proteins in your blood and not immediately available for use.

Your doctor can help you with interpreting whether your lab test results are too low.

If you have low testosterone, Ramin said there are several things you can do to increase it, including:

  • Losing weight
  • Getting good sleep
  • Avoiding processed foods
  • Not smoking pot, which can increase female hormone levels
  • Doing cardiovascular exercise for 30-45 minutes at least three times a week
  • Avoiding alcohol
  • Drinking at least 2 liters of water per day
  • Eating 2-4 eggs with the yolk per week
  • Avoiding soy products

Ramin added that certain supplements might be able to boost your levels as well, such as DHEA, vitamin D3, Tribulus, and maca.

However, you should not take DHEA without your doctor’s supervision since there could be some safety concerns if you have prostate cancer. You should avoid supplements with estrogenic compounds like bioflavonoids as well.

If natural measures don’t help, your doctor can provide you with a prescription for testosterone therapy. This can be administered orally, by injection, or through creams, gels, or patches applied to your skin.