Coronary Heart Disease
A major theoretical concern regarding testosterone administration is the possibility that it could increase the risk of cardiovascular disease. Such a concept is based on the higher incidence of cardiovascular events in men than in women. However, this may be much more readily explicable by protective effects of estrogen in women. There is little data to support a causal relationship between high testosterone levels and heart disease and in fact, a significant body of evidence suggests that the opposite may be true and that men with low testosterone levels may be at higher cardiovascular risk.
There are reports that testosterone replacement can improve symptoms of chronic stable angina and there are direct observations showing vasodilation following intracoronary injections of testosterone. There are no reports of increasing incidence of cardiovascular disease including myocardial infarction, stroke or angina in reports of testosterone replacement therapy.
Polycythemia (an abnormal increase in red blood cells)
A well know side-effect of chronic testosterone administration, particularly using the intra-muscular route (injections), where high serum testosterone levels are present for some weeks following each injection, is the occurrence of polycythemia, with a rise in hematocrit (the percentage of whole blood that is composed of red blood cells). It is noteworthy that men with hypogonadism tend to have anaemia and reduced hematocrit concentrations and testosterone replacement leads to normalisation.
There is a direct dose relationship between testosterone dose and the incidence of polycythemia. This effect, while not life threatening or severe requires the need for regular monitoring (yearly) by a medical professional. If polycythemia occurs, a reduction of the dose of testosterone is required and/or phlebotomy (drawing of blood) to reduce the red blood cell count resolves the situation.
Long term risks with testosterone replacement therapy are minimal, particularly in regard to the major concerns addressed above. Side-effects from excessive testosterone dosing are noted, but such adverse reactions are extremely unlikely with testosterone cream or gel topical administration.
Testosterone Check list
- Identify symptoms
- Consult your local medical professional
- Exclude other factors that may cause symptoms
- Have free and total testosterone levels checked
- Have prostate gland checked (PSA and physical exam).
- If required, commence a three month trial of testosterone then review.
- Have regular monitoring of on-going treatment by a medical professional
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