Question:

    My blood fats are normal. My HDL (good cholesterol) is high, and I'm approaching 54. I was in my doctor's office for a checkup and read one of the pamphlets he had available, which says, with no explanation, that age is the most powerful risk factor for heart disease, especially congestive heart failure (CHF). I don't have CHF or coronary artery disease, or heart disease in general, but because of my age, I am possibly approaching a catastrophic problem. Can you explain why age is the most powerful risk factor for heart disease, when other parameters are normal? My doctor couldn't.

Answer:

    This is a rather involved question, which entails an involved answer in 3 parts, because with age, 3 things happen:

• Body tissues shrink.
• Levels of important hormones such as testosterone, estrogen and human growth hormone, fall. Also,
• Breakdown processes in the body begin to outstrip building-up processes.

All 3 of these items have deleterious effects on your health and your heart.

• Everything Shrinks

First, as we age, everything shrinks. Most people assume just their height shrinks. They lose stature, from 3/4 inch to 1 inch. But if you are shrinking in height as you age, you're also shrinking in the body tissues, such as muscle, liver, kidneys, bone mass, and heart mass. For instance, men over age 85 lose about 25% of their bone mass and are at risk for hip fractures. Women are at risk at even younger ages. [The New Anti-Aging Revolution, Dr. R. Klatz and R. Goldman, Page 51.]

As these tissues shrink, this means they are also putting out less protective factors against heart disease and other illnesses, because the tissues are also losing vitality.

One thing that shrinks in respect to the body shrinkage, especially the heart, is your coronary arteries. This shrinkage will magnify any occlusions that are present, and on systole (when the ventricles of the heart contract to pump blood out), the coronary arteries also contract. You can see the problem here with age. Some occlusion of the coronary arteries, along with shrinkage of the coronary arteries, and with contraction with each heart beat, can lead to a coronary artery occlusive event, or spasm, resulting in angina or a myocardial infarction (heart attack). This occlusion represents what is known as coronary artery disease. [Matthias Rath, M.D., Why Animals Don't Get Heart Attacks But People Do, Page 276.]

If a clot comes through, you can see the problem the heart is in for when it's contracting, because less room is available for the clot to go through and perhaps have a chance to be dissolved by normal body defenses, such as plasminogen, our natural clot buster. Remember, less body defenses are being produced because of this overall body tissue shrinkage with age. [Eugene Shippen, M.D., & William Fryer, The Testosterone Syndrome, Page 82.]

"With every heart beat, the coronary arteries are squeezed flat," but during the relaxing phase, diastole, they are open again. [Matthias Rath, M.D., Why Animals Don't Get Heart Attacks ButPeople Do, Page 276.]

Testosterone and Human Growth Hormone

Two things which help tissues increase back to their normal, youthful sizes are testosterone and human growth hormone (hGH). The New Anti-Aging Revolution, by Ronald Klatz and Robert Coleman, says on page 52 that testosterone "stimulates the growth and repair of muscles and the heart and immune system." Testosterone increases heart muscle mass if it has thinned over the years from lack of testosterone.

The Brewer Science Library website, at http://www.mwt.net~drbrewer/niep_art.htm, points out that:

The influence of testosterone on coronary artery disease has been largely ignored in men.

K.S. Channer, et al., says that testosterone administration may help open up blood vessels. Furthermore, low testosterone has long been associated with

• Low HDL,
• High LDL, and
• High triglycerides, along with
• High blood pressure.

[Channer, KS, et al. "Cardiovascular effects of testosterone: implications of the 'male menopause?'" Heart 2003 Feb;89(2):121-122.]

Testosterone may improve exercise tolerance and reduce pain in men's hearts with coronary artery disease (angina). [English, KM, et al, "Low-dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina: A randomized, double-blind, placebo-controlled study." Circulation. 2000 Oct 17;102(16):1906-1911.]

According to K.M. English, et al, writing in European Heart Journal, "Men with coronary artery disease have lower levels of testosterone than those with normal coronary angiograms." [Eur Heart J. 2000 Jun;21(11):890-894.]

In older men, low testosterone appears to have a negative influence on atherosclerosis and may explain increased coronary artery disease in this age group.

Men don't go into andropause and suddenly have no testosterone as a woman who goes into menopause and in one or two years has complete cessation of estrogen production from her ovaries. In fact, before it was known as male menopause, it was known as male climacteric, a decrease in the sexual functions in the male. Many men and their doctors still do not recognize that the male climacteric is often associated with symptoms of hot flashes, mood swings, etc. similar to the symptoms of menopause in women. Some males experience suffocation. Others experience depression and increased levels of LDL (bad) cholesterol. All these symptoms are relieved by the administration of testosterone. [Textbook of Medical Physiology, 9th Ed., Guyton & Hall, Page 1014.] [Marin P, et. al. "Androgen treatment of abdominally obese men." Obesity Res 1993;1:245-48.] [Ellyin FM. "The long term beneficial treatment of low dose testosterone in the aging male." Proc 77th Meeting of the Endocrine Soc., Washington, D.C., 1995;2-127.]

The authors of The Testosterone Syndrome point out on Page 4 that andropause "...creeps in upon them [men] stealthily, until, at last, they reach a point where they can't help noticing their muscles shrinking, their energy withering, their self-confidence crumbling, and their virility taking a tumble." They have entered the "Gray Zone." This is a time men don't want to discuss, nor do they understand it. Oftentimes, they have depression which manifests as anger. They have lost "aggressive energy"--the ability to solve problems.

The authors continue on Page 5 by pointing out that, "The time that elapses between the first hesitant signals of the male change of life, and its full ugly flowering can easily be 10 or 15 years."

Since a woman has cessation of estrogen during menopause, but a male may still secrete small amounts of testosterone even into old age, the male "change of life" is now no longer known as male menopause, but is now called male andropause.

"In both humans and animals, it [estradiol, one of the 3 estrogen molecules] relaxes arteries and boosts blood flow; it also minimizes thickening of the carotid artery, an indicator of atherosclerosis." [Science, "The Great Estrogen Conundrum," Nov. 14, 2002, Page 1136.]

Dr. Shippen, writing in The Testosterone Syndrome, says it is a "well-known fact that estrogen causes increases in clotting factors as well as narrowing of the coronary arteries in men. Recent research has confirmed that high estrogen levels are associated with increased risk of heart attacks in males--the exact opposite of its effect in females, in whom it [estrogen] certainly has cardioprotective effects, dilating the coronaries, decreasing clotting factors and revving up the body's natural clot-busting system."

In Science, the authors feel the problem with the Women's Health Initiative (WHI) is that

• "the dose [of estrogen] was too high, a sudden boost for women who had lived with lower hormone levels for years."
• They also point out that the type of estrogen and progesterone may be the problem because it was synthetic and not natural.

"Before menopause, the female body gets only intermittent pulses of estrogen and progesterone.

A constant supply of estrogen, researchers say, may dull the sensitivity of estrogen receptors."

And herein may lie the problem.

In short, as men and women age, they are losing youthful, endogenous (natural) hormone levels that appear to protect the heart and dilate the coronary arteries, testosterone in men and estrogen in women.

Interestingly, increased estrogen levels in men causes (1) connective tissue abnormalities, (2) fibrosis (formation of fibrous tissue) which extrapolates to loss of elasticity, which is a cause of high blood pressure, and (3) inflammation. [Ray Peat's Newsletter, November, 2003.] [Inflammation is now recognized as a cause of heart disease. See: www.lef.org; Science, November 7, 2003, Vol. 302, p. 965, and U.S. News & World Report, "The End of Heart Disease," December 1, 2003, Vol. 135, #19, Page. 39.]

All three of these things can generate tears in the coronary arteries or other delicate arteries in the body, setting the stage for atherosclerosis.

Matthias Rath contends that large amounts of Vitamin C, spaced throughout the day, along with taurine, lysine and proline help reduce atherosclerotic plaque in heart disease and has case studies to prove it.

Testosterone appears to help protect against male andropause, which in turn, may offer protection from cardiovascular disease. Life Extension magazine, December, 2003, page 66, points out,

"Everyone recognizes that the risk of developing congestive heart failure (CHF) increases with age, but the fact that the increased risk may be tied to reduced gonadal testosterone production has not yet been completely accepted by practitioners of conventional medicine."

III. Catabolic/Anabolic

In regard to your question, it can be further elucidated that there is a delicate balance between catabolic (breakdown) processes and anabolic (build-up or protein synthesis) processes.

When the anabolic processes are greater than the catabolic, this implies growth and youthful hormone levels, which further implies increased or youthful levels of testosterone and insulin-like growth factor-1 (IFG1), and others.

But as we age, and the anabolism begins to equal catabolism, and catabolism goes into increase, we see an accumulation of too much cholesterol, less efficient carbohydrate metabolism, and other processes that begin accumulating. This leads to dysfunction, which leads to disease.

As catabolism increases, there is a rise in cortisol and a corresponding decrease in DHEA, hGH, testosterone and other hormone levels from youthful (desirable) levels.

According to Klatz in The Anti-Aging Revolution, there are changes in the body mass index and a number of authorities agree that there is a severe possibility of heart failure. [Anker SD, Clark AL, Kemp M. et al. "Tumor necrosis factor and steroid metabolism in chronic heart failure: possible relation to muscle wasting." J Am Coll Cardiol 1997 30(4):997-1001.] [Muller J. "Cholesterol, interactions with testosterone and cortisol in Cardiovascular diseases." Berlin: Springer-Verlag: 1987.]

The main anabolic hormone is testosterone. The main catabolic hormone is cortisol.

You didn't mention whether your blood pressure is high or not, but testosterone therapy reduces blood pressure and at the same time relaxes the brachial arteries where the blood pressure is taken. It has been shown that injecting testosterone directly into the coronary arteries produces dilation and increases coronary blood flow. [Marin P, Holmang S., Jonsson L, et al. "The effects of testosterone treatment on body composition and metabolism in middle-aged, obese men." Int J Obes 1992 16(12):991- 7.] [Ong, PJ, Patrizi G, Chong WC et al. "Testosterone enhances flow-mediated brachial artery reactivity in men with coronary artery disease." Am J Cardiol 2000 85(2):269-72.] [Webb, CM, McNeill JG, Hayward CS, et al. "Effects of testosterone on coronary vasomotor regulation in men with coronary heart disease." Circulation 1999 100(16):1690-6.]

Testosterone therapy may also improve cardiac function by relieving stress on the heart muscle during systole and diastole, and increasing the blood flow through the coronary arteries. We now know that testosterone does--indeed--relax coronary arteries: This keeps down coronary spasms and less use of nitroglycerine.

Dr. Matthias Rath, in his book, Why Animals Don't Get Heart Attacks But People Do, points out in numerous places that many people have averted a heart attack and reduced plaque or cleared it from their coronary arteries by following his method of applying cellular nutrients. These people had been having angina and had coronary artery scans on an ultrafast CT scanner, showing they had occlusions that were generating heart pain. On following his plan of cellular nutrients, they reduced the occlusions, and some of the arteries became patent again.

You can get testosterone in patches, gels, implants, buccal release, injections and creams. We suggest that the easiest and safest to use is the natural testosterone cream. Without elaboration, avoid the testosterone shots, especially methyl testosterone, as it has been implicated in liver damage.

We also suggest hGH therapy and a host of anti-aging nutrients you can find discussed at www.lef.org.

Find a knowledgeable doctor who knows how to test for these things, to see where you are, according to age, on the hormonal scale, and who will administer the therapy accordingly. But remember, you need testing--regular testing, when you enter into this kind of therapy.

If you use an internet pharmacy and physician. You will not have a personal or face to face interaction with your physician, unless they are into---some are---web cams. This source is for use by people who are willing to do regular testing to monitor their progress. Some tests you will need to run regularly are Free Testosterone, Total Testosterone, Sex-Hormone-Binding Globulin (SHBG), Estradiol, PSA, and a CBC with a liver panel and regular blood chemistry, including a PSA test. Have these tests performed before beginning therapy, and 6 weeks after beginning therapy. By doing so, you may discover you need less testosterone, save money, and the tests help rule out prostate cancer. These tests may also show your blood fats are being reduced, or are normal, such that you can reduce or stop taking a statin drug you may be on at present. [Life Extension, October, 2003, Page 74.] It would also be advisable to have a digital rectal exam from your doctor.

If your doctor is willing to work with you and is not up on optimum youthful hormone levels for males versus aging male hormone levels, then be advised of the following: "...blood test laboratory reference ranges are age-adjusted to reflect the anticipated reduction in testosterone production. So, when a doctor looks at an aging man's free testosterone blood test result, he often sees it fitting neatly into the standard reference range for a normal aging man. The problem is that normal aging men are expected to have lower testosterone levels, which are far from optimal (youthful) ranges. The optimal testosterone level for most aging males are those of a healthy 21-to-30 year old." [Life Extension, October, 2003, Pages 65-66; ibid"20-29 year old" (women)...April, 2006, p.54]

What this means is that you want the hormone levels of a healthy 21-30 year old male. You don't want your doctor saying, "Oh! You are falling within normal testosterone levels for your age," and you are falling apart! Get the message? You want youthful hormone levels to help slow down the aging process. Coronary artery disease is considered a degenerative, aging process. So are those subtle symptoms of slowing natural testosterone production you may be starting to notice: declining strength and energy, and "a depressive change in personality quite apparent to wife and friends." [Testosterone Syndrome, Page 8.]

And if your doctor still balks, point out to him that HealthCheck, Inc., (a laboratory testing firm which uses Lab One) in the state of Texas, in their brochure advertising the blood tests they offer, points out for the first time: "TESTOSTERONE: For men and women concerned about osteoporosis, low muscle-mass, depression, sexual function, and anemia." Testosterone has come of age!

If he's too hard-headed to follow this top lab and their recommendations, then give him a copy of The Testosterone Syndrome, by Eugene Shippen, M.D. and William Fryer, to educate him, and be prepared to find another doctor.

This Update article and its references should also give you plenty of ammunition when you talk with your doctor about hormone replacement therapy.

Remember, androgen therapy is no longer about sex anymore-- it's about:

• Muscle mass,
• Bone mass,
• Get-up-and-go, and
• Feeling good, and
• Also about helping to prevent heart disease.

I can hear what you're thinking: "If this be so about testosterone and the heart, why don't more cardiologists use testosterone therapy?"

It is because they are still practicing that portion of medicine from the 70's and 80's, when it was believed that testosterone caused heart disease. It is now well known that testosterone PREVENTS heart disease.

As one retired physician puts it, "Doctors tend to be down on what they're not up on."

On this matter in regard to cortisol, once you build back your bone and muscle mass through hard exercise and androgen replacement therapy, you don't want to lose it at night during sleep. Why does this happen? Again, it's because of cortisol.

At 2 A.M., the hormone cortisol that is naturally produced by your body is at its 24-hour zenith. It tells your hard-earned muscle mass to be turned into amino acids, to be turned into sugar. There's the difficulty. You are now losing what you spent time and money building up. Why? Because cortisol shuts down testosterone and ups myostatin (a protein that prevents muscle cells from growing). With cortisol riding high when you go to sleep, testosterone can't bind or stay bound to its receptors. Your cells pump out myostatin, and with myostatin riding high, your muscles can't grow.