Sex hormones and your heart

Senior couple drinking morning coffee in bed.

The two main sex hormones — estrogen and testosterone — have wide-ranging effects in the body. Produced primarily by the ovaries (estrogen) and testes (testosterone), these hormones affect not just your sexual function but also your bones, brain, and blood vessels, for example.

As people age, the natural decline in sex hormone levels sometimes causes undesirable symptoms, such as hot flashes or a flagging sex drive. Doctors can prescribe pills, patches, gels, and creams containing estrogen or testosterone to ease those symptoms. But are these products safe for your heart?

Hormone therapy has a long, controversial history, especially with regard to estrogen. For women, advice about estrogen therapy has shifted dramatically over the decades in response to research findings. But for men, recommendations regarding testosterone aren’t as robust because of a dearth of long-term studies of men taking this hormone. Following is a summary of what we know — and don’t know — about the cardiovascular effects of hormone therapy.

Estrogen therapy

For decades, many women took estrogen (often combined with progesterone, another sex hormone) starting around menopause, when hormone levels start dropping. Some sought relief from hot flashes, vaginal dryness, and other menopause-related symptoms. But some doctors routinely prescribed hormone therapy to most of their female patients — regardless of their symptoms — based on observational data that it would help prevent heart disease and osteoporosis. “At the time, pharmaceutical companies touted the benefits of hormones, and there was a ‘medicalization’ of menopause,” says Dr. Kathryn M. Rexrode, associate professor of medicine at Harvard Medical School and chief of the Division of Women’s Health at Brigham and Women’s Hospital.

But in 2002, the landmark Women’s Health Initiative found that the most commonly prescribed form of hormone therapy actually increased a woman’s risk of cardiovascular disease, such as heart attack and stroke. (Of note, the participants’ average age was 63, more than a decade after menopause usually begins.) The FDA added a warning label about the potential health risks from estrogen products, and prescriptions for hormone therapy dropped sharply soon afterward.

Although most women aren’t terribly bothered by menopausal symptoms, a small percentage have uncomfortable, frequent hot flashes that disrupt their sleep and daily function, says Dr. Rexrode. If lifestyle changes don’t help, hormone therapy is an option for women without high cardiovascular risk. Using estrogen for a few years after menopause (which begins at age 51, on average) doesn’t appear to causes major changes in blood vessel function, recent studies suggest.

For women who need hormones, those taken transdermally — that is, delivered through a small patch placed on the skin — are less likely to trigger blood clots than hormones taken in pill form, and are therefore generally a better choice, says Dr. Rexrode. Women who want to try hormone therapy should first have a doctor assess their risk of heart disease. Take the lowest possible dose for the shortest possible time, which will require annual check-ins with your doctor, she advises. Also, vaginal estrogen products (creams, suppositories, and rings), which can relieve vaginal dryness and discomfort during sex, do not appear to be linked to any increased health risks, she adds.

Testosterone therapy

Unlike estrogen levels, which drop rather abruptly when a woman reaches her late 40s to early 50s, testosterone levels in men decline gradually, beginning around their mid-20s. But the trends for treating these age-related hormone drops have some similarities.

Testosterone therapy is approved only for men who have testosterone deficiency caused by a disorder of the testicles, pituitary gland, or brain. Known as hypogonadism, this can cause symptoms such decreased beard and body hair and loss of muscle mass, as well as lack of interest in sex, low energy levels, and depressed mood. But about a decade ago, pharmaceutical companies began marketing the hormone to treat vaguer symptoms associated with aging. As a result, testosterone prescriptions soared.

In 2015, after some studies linked testosterone use with a higher risk of heart attack and stroke, the FDA added a warning about that possible danger to product labels. Since then, testosterone prescriptions have dropped substantially.

In fact, the evidence regarding testosterone’s effects on the heart has been mixed, with some studies suggesting benefits or no effect and others hinting at harm. “There is insufficient evidence to determine whether testosterone increases the risk of major cardiac events,” says Dr. Shalender Bhasin, an endocrinologist at Harvard-affiliated Brigham and Women’s Hospital. We may know more in a few years, when an FDA-mandated trial to assess the cardiovascular risks associated with testosterone treatment in middle-aged and older men with testosterone deficiency is complete. Testosterone is usually given as a gel rubbed into the skin, a transdermal patch, or by injection.

Often, mildly low testosterone stems from obesity and diabetes, and treating those problems with lifestyle changes may boost testosterone levels and improve symptoms, says Dr. Bhasin.

Still, men with troubling sexual dysfunction and fatigue may want to ask their doctors about checking their testosterone levels, he says. For men who are 65 and older with low testosterone (less than 300 milligrams per deciliter), research suggests that testosterone therapy improves libido and sexual satisfaction, as well as other age-related issues such as low bone density and anemia. Although the potential risks of testosterone therapy aren’t fully understood, the improvements in quality of life may be worthwhile for some men, says Dr. Bhasin.

Compared with our distant ancestors, we now spend a far greater fraction of our lives past our reproductive years, Dr. Bhasin notes. “I think it’s worth considering whether and how we can reduce suffering from the consequences of reproductive aging caused by low hormone levels in both men and women.”

Below are spiritual recipe for health and wellness: Matthew E. McLaren

Psalm 27:1 “The LORD is my light and my salvation; whom shall I fear? The LORD is the strength of my life; of whom shall I be afraid?”

Psalm 37:39 “But the salvation of the righteous is from the LORD; He is their strength in time of trouble.”

Psalm 138:3 “In the day when I cried out, You answered me, and made me bold with strength in my soul.”

Matthew 19:26 “But Jesus looked at them and said to them, ‘With men this is impossible, but with God all things are possible.’”

2 Corinthians 4:16 “Therefore we do not lose heart. Even though our outward man is perishing, yet the inward man is being renewed day by day.”

Philippians 4:13 “I can do all things through Christ who strengthens me.”

2 Timothy 1:7 “For God has not given us a spirit of fear, but of power and of love and of a sound mind.”

Psalm 8:2 “Out of the mouth of babes and nursing infants You have ordained strength, because of Your enemies, that You may silence the enemy and the avenger.”

Psalm 18:1-2 “I will love You, O LORD, my strength. The LORD is my rock and my fortress and my deliverer; my God, my strength, in whom I will trust; my shield and the horn of my salvation, my stronghold.”

Psalm 18:32 “It is God who arms me with strength, and makes my way perfect.”

Psalm 19:14 “Let the words of my mouth and the meditation of my heart be acceptable in Your sight, O LORD, my strength and my Redeemer.”

Psalm 22:19 “But You, O LORD, do not be far from Me; O My Strength, hasten to help Me!”

Psalm 28:7-8 “The LORD is my strength and my shield; my heart trusted in Him, and I am helped; therefore my heart greatly rejoices, and with my song I will praise Him. The LORD is their strength, and He is the saving refuge of His anointed.”

Psalm 29:11 “The LORD will give strength to His people; the LORD will bless His people with peace.”

Psalm 46:1 “God is our refuge and strength, a very present help in trouble.”

Psalm 54:1 “Save me, O God, by Your name, and vindicate me by Your strength.”

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