Testosterone Replacement in Men

A critically important role of testosterone is to enable HDL to remove excess cholesterol from the arterial wall and transport it to the liver for disposal. This effect of enhancing HDL is termed “reverse cholesterol transport” and is vital to preventing arterial occlusion.

Cells throughout a man’s body are laden with receptor sites that are activated by the hormone testosterone. When testosterone is available to bind to these receptor sites, good things happen such as elevated mood and improved cognition in response to plentiful testosterone being available to the brain. Be it muscle, bone, vascular, or nerve tissue, testosterone provides critical command signals for your cells to behave in a youthful manner.8,26-33 As testosterone levels diminish, degenerative processes set in. Data was tabulated based on hospital reports and/or death certificates for heart attack, stroke, unstable angina, bypass surgery, or stenting.

The four quartiles of total testosterone in this large group of older men were:

• Quartile 1: Total testosterone below 340 ng/dL.
• Quartile 2: Total testosterone be-tween 341-438ng/dL.
• Quartile 3: Total testosterone be-tween 439-549 ng/dL.
• Quartile 4: Total testosterone above 550 ng/dL.

Of interest was the finding that Quartiles 1, 2, and 3 had about the same risk of cardiac adverse events. It was only in Quartile 4 (when total testosterone exceeded 550 ng/dL) that the 30% reduction in cardiovascular events occurred.  This finding showed that it did not matter if these men’s total testosterone was very low (below 340 ng/dL) or moderately low (up to 549 ng/dL)…they all had a similar increased risk for suffering a cardiovascular event. Only when total testosterone exceeded 550 ng/dL did cardiovascular risk plummet. This finding remained consistent for cerebrovascular disease incidence, where men with the highest total testosterone (Quartile 4) had a 24% reduced risk of transient ischemic attack or full-blown stroke. The researchers noted this association with reduced cerebrovascular risk remained after adjustment for traditional risk factors. It has long been known that aging men are at risk for having excess activity of an enzyme called aromatase. The effect of surplus aromatase is that too much testosterone is converted to estrogen. Aging men have a propensity to develop dangerously high levels of estrogen combined with woefully inadequate testosterone, though many aging men suffer both low testosterone and estrogen. Elevated estrogen can sharply increase heart attack risk by promoting platelet aggregation and coagulation in coronary arteries.41,42 Higher estrogen in men also increases inflammation which can cause unstable plaque to rupture and occlude a coronary artery, thus creating a sudden heart attack.

• Testosterone elevates the hepatic lipase enzyme that the liver needs to safely clear the body of excess cholesterol.
• The liver contains a receptor called scavenger receptor B1 that acts to stimulate cholesterol uptake for processing and disposal. Testosterone beneficially increases scavenger receptor B1.
• Furthermore, a liver enzyme called hepatic lipase functions to remove phospholipids from the surface of HDL and helps enhance the uptake of these HDL-derived lipids by scavenger receptor B1.
• Testosterone increases the activity of hepatic lipase.10
• By increasing both scavenger receptor B1 and hepatic lipase activities, testosterone facilitates an increase in reverse cholesterol transport, a process that removes excess cholesterol from the tissues and carries it to the liver for processing and disposal.

Summary of article in Life Extension Magazine by William Faloon.

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