Testosterone Therapy and Cardiovascular Risk


Many of our patients are initially concerned regarding the safety of testosterone replacement therapy.


Many of our patients are initially concerned regarding the safety of testosterone replacement therapy. I want all of my patients to always be able to share any concerns with me and this is probably the most frequent question I hear.

A lot people have questions given what has been in the media recently. Unfortunately, the media tends to hype whatever will sell more papers rather than good science. Here is an excellent article from a very reputable source, the Mayo Clinic, that is very in depth. It reviews many scientific articles regarding the safety of testosterone replacement therapy.

It is quite long and full of a lot of medical jargon but bottom line up front – testosterone replacement therapy is safe and in fact actually beneficial to patients’ cardiovascular health. Like any medication, you must select the proper patient population and then provide monitoring after administration. This is no different from how I would treat any other prescribed medication.


Here is a little synopsis:

“Only 4 articles were identified that suggested increased CV risks with T prescriptions: 2 retrospective analyses with serious methodological limitations, 1 placebo-controlled trial with few major adverse cardiac events, and 1 meta-analysis that included questionable studies and events. ”

All of the studies that they found that suggested any risks with testosterone therapy were significantly flawed studies. This is something the media will never tell you. They do not analyze the studies for quality, they only cover them if it makes an interesting headline.

“In contrast, several dozen studies have reported a beneficial effect of normal T levels on CV (cardiovascular) risks and mortality. Mortality and incident coronary artery disease are inversely associated with serum T concentrations (LOE IIa), as is severity of coronary artery disease (LOE IIa). Testosterone therapy is associated with reduced obesity, fat mass, and waist circumference (LOE Ib) and also improves glycemic control (LOE IIa). Mortality was reduced with T therapy in 2 retrospective studies.”

Inversely associated means that as testosterone levels increased, mortality and incident coronary artery disease decreased. Other studies showed multiple other benefits including the biggest of all – decreased mortality.


“Several RCTs in men with coronary artery disease or heart failure reported improved function in men who received T compared with placebo. The largest meta-analysis to date revealed no increase in CV risks in men who received T and reduced CV risk among those with metabolic disease.”

RCT stands for randomized controlled trial. It is the gold standard for design in a medical study. So the best type of scientific study that there is found improved heart function. A meta-analysis is when we take a bunch of studies and combine them and look at their aggregate findings. When done properly, this is a very powerful method because it gathers data from many patients. This well done meta-analysis shows reduced CV (cardiovascular) risk.

After looking at the evidence, I believe that testosterone therapy it is truly safe and actually quite beneficial. Like all medical therapies, it must be done correctly and with close monitoring. This is why I believe that all of these “low T” clinics that you see popping up all over the place are unsafe. I do not believe that they do a thorough enough evaluation of their patients and they do not provide close monitoring. They also only evaluate one hormone (we evaluate almost a dozen). Optimized hormones are only one aspect of healthy aging. Our program is founded on the most thorough evaluation available, a fully individualized plan and very close monitoring by your physician, exercise counselor and nutritionist.

Read the original article by clicking on this link.

Health Care vs. Sick Care


Preventative action makes all the difference.

Too much of modern medicine has become about waiting for disease to develop then trying to do something about it after it is too late.At Elite Health Hawaii, we take a truly proactive approach to preventing diseases such as heart disease, strokes, dementia and cancer from ever developing in the first place. Our in depth, comprehensive executive health evaluation allows us to see signs of disease 5 to 10 years before it develops then to take action to prevent the manifestation. We recognize the little red flags and take action before they become issues.

Waiting for patients to develop high blood pressure or high cholesterol or obesity or diabetes and then giving medications to try to address these issues is not prevention. We address the underlying disease processes rather than giving people medications to cover up what are actually symptoms of the true underlying disease process. For example, many of our patients come to us and report they’ve been told that they have normal blood sugar levels so they are not diabetic or pre-diabetic.

If you are even 20-30 pounds overweight, it is highly likely that you are already experiencing insulin resistance and that you have elevated insulin levels. Even mildly elevated blood glucose levels, levels considered normal by most primary care providers, are associated with increased risk for the early development of dementia. We actually evaluate the insulin levels themselves, not just the blood glucose levels. This is one way we are able to spot impending disease before it develops and take action to prevent the development of diabetes.

Do not sit back and wait around for disease to develop, join on of  our comprehenseive proactive health programs and take control of your health.

The Silent Killer

Chronic Inflammation is an asymptomatic problem that we should all look out for.

Chronic inflammation is killing millions and almost nobody is talking about it. I recently read an article regarding chronic inflammation that I think does a very good job of summarizing the effects of chronic low grade inflammation. Chronic inflammation is often asymptomatic, you have no idea that it is at work inside you until you develop disease unless you get checked. More and more studies are coming out linking chronic inflammation with heart disease, diabetes, cancer and early onset dementia. Here’s a quick summary in case you don’t have time to read the article.

Half of all heart attacks happen in people with normal cholesterol levels. It is chronic inflammation which destabilizes plaques in the blood vessels and leads to heart attacks. This is also a likely mechanism leading to strokes.

Higher levels of inflammation increase your risk for developing diabetes. Central adiposity or “Belly Fat” releases inflammatory molecules which increase your risk for diabetes as well as many other diseases. We used to think that fat was inactive but we now understand that it is quite active and is like a sack of poison hanging around your mid-section. Elite Health Hawaii can help you get rid of as much of this belly fat as possible not only to help you look better but to decrease your risk for heart disease, cancer, strokes and dementia.

Chronic inflammation has been associated with cellular damage which can lead to cancer. It has also been linked to the development of precancerous colon polyps as well as esophageal cancer.

Alzheimer’s disease is associated with chronic activation of brain cells that lead to inflammation. Research suggests that aspirin and fish oil, both anti-inflammatory substances, may be useful in preventing dementia.

At Elite Health Hawaii, we not only assess your level of inflammation but we also give you the means to reduce the inflammation. Chronic low grade inflammation is the common thread among multiple diseases and the importance of reducing this inflammation can not be overstated.

Here’s a link to the article: http://www.inflammationresearchfoundation.org/inflammation-science/inflammation-details/time-cellular-inflammation-article.