How are Low T, Erectile Dysfunction, and Heart Health Related? And Why Should You Care?

How are Low T, Erectile Dysfunction, and Heart Health Related? And Why Should You Care?

Men’s sexual health and heart health are undeniably linked. When you address important issues such as low testosterone and erectile dysfunction you’re also addressing other critical aspects of your health.

It’s as important to understand both how sexual health and heart health are connected as it is to understand the treatment options available. Nearly daily men ask their doctors questions like “does low testosterone cause heart problems” or “Is there a connection between erectile dysfunction and heart disease?” The short answer is yes, but read on.

When men have these conversations with their physicians they have a much higher likelihood of discovering or preventing cardiovascular issues early, maybe even years earlier than if they wait and do nothing. Doing nothing is unfortunately a hallmark of many men’s approach to their sexual health until they experience certain difficulties such as issues with erections. Even then many still wait thinking it’s a function of aging.

It’s not.

Regular check-ups are as important for men as they are for women. Even if you “feel fine”, you should approach sexual health as you would any routine check-up. Women book regular annual appointments for their sexual and reproductive health, but with so few true men’s sexual health specialists in the field, many men never consider the importance of doing the same or don’t know when or where to seek help.

The connection between heart health and men’s sexual health is undeniable. 50 percent of men who die from ischemic heart disease reportedly had no previous heart symptoms before their deaths, and between 70% to 89% of sudden cardiac arrests occur in men. However, many times, erectile dysfunction will be the early warning symptom that could head off a devastating event.

What is Cardiovascular Disease?

Before we dive into heart health and how its linked to men’s sexual health we need to take a look at what cardiovascular disease is and what we can do to prevent it.

Cardiovascular disease is a term that covers many issues including heart disease, heart attack, stroke, heart failure, arrhythmia, and heart valve problems.

Some symptoms of cardiovascular disease include:

    • Chest pain or chest tightness
    • Shortness of breath
    • Pain, numbness, weakness or coldness in your legs or arms
    • Pain in the neck, jaw, throat, upper abdomen or back

There are several causes of heart disease but often they are caused by poor but correctable lifestyle behaviors with unhealthy diet, lack of exercise, being overweight, and smoking at the top of the list. Prevention is key to avoiding future issues. We encourage an overall health conversation with our patients to better understand their risk profiles and to help them create a health plan that will keep them as healthy as possible for the rest of their life.

If you have a family history of cardiovascular issues, it’s especially important to be aware of your heart health and make healthy lifestyle decisions to prevent issues from occurring.

What is Testosterone and What are the Symptoms of Low T?

Testosterone is an important hormone for men. It’s also core to good reproductive health. Testosterone is the hormone in men that serves as the primary sex hormone, and is responsible for the development of male sex organs and creates male physical characteristics. It also affects sexual drive and impacts mood and energy. Therefore, it’s no surprise that when testosterone gets low it leads to lower libido, a poor mood, and lack of energy.

Low testosterone is a natural effect of aging in men. In fact, testosterone levels can lower 1-2% every year beginning around the age of 40. Symptoms of low testosterone include low sex drive, erectile dysfunction, and low energy. Even though low testosterone is common among aging men, the symptoms are hard to live with on a daily basis and for many men, generally unnecessary. A thorough health exam followed by a comprehensive treatment plan that is managed by man and sometimes medicine can have you back in the saddle and feeling great in no time.

How is low testosterone diagnosed?

Your healthcare provider will take a blood sample and test for “serum testosterone”. It may be necessary to take this test several times since testosterone levels can change depending on the time of the day and other variables. Testosterone levels are measured on a range. Normal male testosterone levels range from 300 to 1,200 nanograms per deciliter. Even if your testosterone levels test below 300, it doesn’t necessarily mean that low testosterone is a chronic issue which is why multiple tests are needed to make an appropriate diagnosis.

Providers should also consider other factors of your health including chronic illnesses, medications, diet, sleeping patterns, and more. These are all important to ensure that you get a correct diagnosis and treatment.

Did you know that you can test as having low testosterone, but it’s not necessarily your testes that are failing you? You may be having other issues that lower testosterone levels including diabetes/pre-diabetes, high blood pressure, high cholesterol, kidney problems, obesity, or other chronic issues. This would mean that receiving testosterone treatment won’t be as effective because the core issue isn’t being addressed. Treating the whole man is the key to strong testosterone markers at every age. There is no reason a 70 year old man shouldn’t have a firm erection, vibrant energy, and be clear headed as he heads out into his day.

Testosterone and Heart Health

It’s hard for researchers to fully understand all the causes of heart disease. There are many contributing factors including family history, diet, age, gender, blood pressure, chronic diseases like diabetes, and more.

It’s hard to definitively say if or how low testosterone causes heart problems but we do know they’re linked.

Can low testosterone cause heart problems?

If you suspect you have low testosterone levels, it’s recommended you get tested. Low T levels have been shown to increase the risk of developing coronary artery disease (CAD). For men with congestive heart failure (CHF), it’s a warning of something more serious including increased likelihood of mortality. CHF also involves multiple pathways including the endocrine system and low T levels were found in all classes of heart failure.

Whether low T causes negative cardiovascular events or is merely associated with them has yet to be determined, but regardless of a clear distinction between the two, testosterone levels should be monitored closely to ensure better heart health.

There is however another connection between low T and erectile dysfunction to explore, which is another important aspect of men’s sexual health.

Low Testosterone and Erectile Dysfunction (ED)

Low T can contribute to erectile dysfunction, but treatment for low testosterone hasn’t proven to correct ED. Studies show that not all patients who have ED and low testosterone saw an improvement in erectile function after receiving testosterone treatment.

Erections are clearly dependent on hormones like testosterone. What isn’t clear is the level of testosterone where ED occurs in men. Although disorders of the endocrine system (your hormone system) are the rarest cause of ED, among that category, hypogonadism is the most common cause. Hypogonadism is the reduction or absence of hormone secretion from the testes. There is, however, little evidence to suggest that treating hypogonadism would, in fact, improve erectile function.

One study even suggests that although both, hypogonadism and erectile dysfunction, can occur in a male at the same time, they may not even be causally related.That means erections don’t require normal testosterone levels. Even after correcting testosterone levels, a man can still have erectile dysfunction. All of this research suggests ED’s main cause is not a hormone issue. So if not a direct result of low testosterone, men’s main sex hormone, what’s to blame?

Erectile Dysfunction and Cardiovascular Issues

The connection between testosterone and heart health exists, although that connection is not as clear as health professionals and researchers would like. Erectile dysfunction, on the other hand, is more widely documented and is an incredibly important factor in helping men address their existing or potential cardiovascular issues.

What is Erectile Dysfunction (ED)?

Erectile dysfunction is difficulty getting or maintaining an erection. Having an occasional issue with an erection can happen to many men, however, once you get to a point where erection problems occur more than half of the time, it’s time to seek medical help regarding ED.

Many men are embarrassed and don’t seek help, which means they often remain undiagnosed and untreated. For that reason, we’ve made it our top priority to ensure patients feel comfortable discussing sexual health with us.

There are many factors that can cause erectile dysfunction. As we mentioned earlier, many people mistakenly believe low testosterone is a major cause of ED, but there are other more likely causes and it’s important to have a full physical exam to determine those causes. Often times, ED indicates other underlying health issues including cardiovascular disease, high blood pressure, or type 2 diabetes. There may also be psychological issues causing or exacerbating ED.

Other causes for erectile dysfunction include:

    • Atherosclerosis
    • High cholesterol
    • Obesity
    • Metabolic syndrome
    • Parkinson’s disease
    • Multiple sclerosis
    • Alcoholism
    • Substance abuse
    • Sleep disorders
    • Prostate cancer
    • Medications

Can Erectile Dysfunction be a Sign of Cardiovascular Disease?

Poor ability to maintain an erection is an early marker of vascular disease. One study suggests that erectile dysfunction increases among men from the ages of 40 to 69 who have diabetes, heart disease, and hypertension. If you engage in an unhealthy lifestyle and fail to treat known cardiovascular issues, your ED will not only continue, it’ll worsen over time.

Another recent study says that erectile dysfunction is an independent predictor of future cardiovascular problems across all ethnicities. Almost 2,000 participants were analyzed for over three years, and it was discovered that those with ED had a significantly greater chance of cardiovascular disease than those who didn’t report having erection issues. The study concluded this provided the strongest evidence so far that ED was a strong predictor of future cardiovascular issues.

A 2013 study says that erectile issues often precede cardiovascular diseases and is often present with those who already have cardiovascular problems. The study suggests that if a person knows they have cardiovascular disease, then they should also be asked about erectile function. Otherwise, this could lead to undiagnosed ED having a significant negative impact on a man and his partner. Address ED as early as possible to prevent future problems.

Sometimes you may not notice any heart issues until you have a heart attack, stroke, or heart failure. This is why it’s important to notice any possible symptoms, including erectile dysfunction, and report it to your physician. Cardiovascular disease can be detected early on if you are proactive about it, and it is easier and more effective to treat it in the early stages.

This is why at The Billups Center we believe in providing thorough medical examinations. A full assessment helps us determine the exact cause of erectile dysfunction in an individual so we can create an appropriate treatment plan and involve other professionals when necessary. It also allows us and you to communicate about your health with your primary care doctor.Your health is a team effort and each of us, especially you, play a key role.

Erectile Dysfunction and Cardiovascular Disease Treatment

So what is the best way to treat erectile dysfunction and cardiovascular disease?

ED & cardiovascular issues are often linked to poor nutrition, and changing your diet is one thing you can do immediately to help reverse your symptoms. One recent study took 740 participants from four countries and recorded the effects of that lifestyle modification. The adjustments were associated with a statistically significant improvement in sexual function, and the changes the participants made have also been shown to reduce the risk of cardiovascular disease.

Here are some suggestions to help maintain a healthy lifestyle:

    • Stop smoking

If you or someone in your household smokes, now is the time to quit. It’s a tough habit to break, but there are lots of resources to help you quit including advice from your doctor.

    • Choose good nutrition

A healthy diet is the best way to fight many health problems including cardiovascular issues, cholesterol, diabetes, and blood pressure. Choose nutrient-dense foods and limit your intake of sugar.

    • Lose excess weight

Obesity is a problem in America, and it affects your body by increasing your chances of getting high cholesterol, high blood pressure, and type 2 diabetes which also increases the likelihood of getting a cardiovascular disease.

    • Be physically active

Keep your body healthy by being physically active. If you are struggling with this, start out with a few minutes and then slowly increase your activity level. It’s recommended to exercise at a moderate level for at least 150 minutes per week.

    • Manage your diabetes

If you have diabetes, then it’s critical to take care of it. Monitoring your blood sugar can prevent even more serious health issues in the future including cardiovascular problems.

    • Reduce stress

Not all stress is avoidable, but you can learn healthy ways to cope with reducing stress. Learn stress management tools to lower chances of heart disease.

    • Limit alcoholic drinking

Drinking too much alcohol can lead to high blood pressure, stroke, and other problems. It’s best to monitor what you’re drinking to ensure you stay within recommended limits.

The Billups Center team provides full and comprehensive exams to ensure you and every patient gets a personalized examination and medical treatment plan. We take the time to properly educate, evaluate, and monitor treatment. Your visit at The Billups center is not like most visits where the doctor is in and out before you finish your thought. We spend the amount of time necessary to understand you as a patient and as a man.

When you schedule an appointment with us, we’ll not only successfully evaluate and treat your sexual health concerns, but we’ll also address all aspects of your health and help you proactively approach any chronic medical conditions or underlying health issues.

We specialize and focus on men’s sexual health only, but because there’s such a strong connection to other health issues we also work closely with other healthcare providers and specialists to ensure your overall health gets treated properly as well. Request an appointment today to and discover how we can help you feel young again.

Diagnosis and Treatment of Erectile Dysfunction for Reduction of Cardiovascular Risk

PURPOSE: We established erectile dysfunction as an often neglected but valuable marker of cardiovascular risk, particularly in younger men and men with diabetes. We also reviewed evidence that lifestyle change, combined with informed prescribing of pharmacotherapies used to mitigate cardiovascular risk, can improve overall vascular health and sexual functioning in men with erectile dysfunction.

MATERIALS AND METHODS: We performed a PubMed® search for articles and guidelines pertinent to relationships between erectile dysfunction and cardiovascular disease, cardiovascular and all cause mortality, and pharmacotherapies for dyslipidemia and hypertension. The clinical guidance presented incorporates the current literature and the expertise of the multispecialty investigator group.

RESULTS: Numerous cardiovascular risk assessment tools exist but risk stratification remains challenging, particularly in patients at low or intermediate short-term risk. Erectile dysfunction has a predictive value for cardiovascular events that is comparable to or better than that of traditional risk factors. Interventional studies support lifestyle changes as a means of improving overall vascular health as well as sexual functioning. Statins, diuretics, β-blockers and renin-angiotensin system modifiers may positively or negatively affect erectile function. Furthermore, the phosphodiesterase type 5 inhibitors used to treat erectile dysfunction may have systemic vascular benefits.

CONCLUSIONS: Erectile dysfunction treatment should be considered secondary to decreasing cardiovascular risk. However, informed prescribing may prevent worsening sexual function in men receiving pharmacotherapy for dyslipidemia and hypertension. As the first point of medical contact for men with erectile dysfunction symptoms, the primary care physician or urologist has a unique opportunity to identify those who require early intervention to prevent cardiovascular disease.

Ex Vivo Model of Human Penile Transplantation and Rejection: Implications for Erectile Tissue Physiology

Ex Vivo Model of Human Penile Transplantation and Rejection: Implications for Erectile Tissue Physiology

BACKGROUND: Penile transplantation is a potential treatment option for severe penile tissue loss. Models of human penile rejection are lacking.

OBJECTIVE: Evaluate effects of rejection and immunosuppression on cavernous tissue using a novel ex vivo mixed lymphocyte reaction (MLR) model.

DESIGN, SETTING, AND PARTICIPANTS: Cavernous tissue and peripheral blood mononuclear cells (PBMCs) from 10 patients undergoing penile prosthesis operations and PBMCs from a healthy volunteer were obtained. Ex vivo MLRs were prepared by culturing cavernous tissue for 48h in media alone, in media with autologous PBMCs, or in media with allogenic PBMCs to simulate control, autotransplant, and allogenic transplant conditions with or without 1μM cyclosporine A (CsA) or 20nM tacrolimus (FK506) treatment.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Rejection was characterized by PBMC flow cytometry and gene expression transplant array. Cavernous tissues were evaluated by histomorphology and myography to assess contraction and relaxation. Data were analyzed using two-way analysis of variance and unpaired Student t test.

RESULTS AND LIMITATIONS: Flow cytometry and tissue array demonstrated allogenic PBMC activation consistent with rejection. Rejection impaired cavernous tissue physiology and was associated with cellular infiltration and apoptosis. CsA prevented rejection but did not improve tissue relaxation. CsA treatment impaired relaxation in tissues cultured without PBMCs compared with media and FK506. Study limitations included the use of penile tissue with erectile dysfunction and lack of cross-matching data.

CONCLUSIONS: This model could be used to investigate the effects of penile rejection and immunosuppression. Additional studies are needed to optimize immunosuppression to prevent rejection and maximize corporal tissue physiology.

Serum vitamin D and sex hormones levels in men and women

Serum vitamin D and sex hormones levels in men and women

INTRODUCTION: 25-hydroxyvitamin D [25(OH)D] deficiency has been associated with low testosterone levels in men, but there are conflicting reports of its associations with sex hormones in women. Less is known about whether these associations are independent of adiposity and lifestyle factors, and whether they differ by race/ethnicity.

AIM: To examine associations of 25(OH)D concentrations with sex hormone levels.

METHODS: Cross-sectional analysis of 3017 men and 2929 women in a multi-ethnic cohort.

MAIN OUTCOME MEASURES: Testosterone, estradiol, dehydroepiandrosterone (DHEA), sex hormone binding globulin (SHBG), and free testosterone.

RESULTS: The mean (SD) levels of 25(OH)D in men and women were 25.7(10.4) and 26.1(12.0)ng/ml, respectively. In men, after adjusting for demographic and lifestyle variables, a 10ng/ml [25nmol/L] decrease in 25(OH)D was associated with an average difference of -0.70nmol/L (95%CI -1.36, -0.05) in SHBG and 0.02 percent (0.01, 0.04) in free testosterone, but was not associated with low total testosterone level (<10.41nmol/L). In women, a 10ng/ml decrease in 25(OH)D levels was associated with an average difference of -0.01nmol/L (-0.01, -0.00) for estradiol, -8.29nmol/L (-10.13, -6.45) for SHBG, 0.06 percent (0.04, 0.07) for free testosterone, and 0.40nmol/L (0.19, 0.62) for DHEA. There was no significant interaction by race/ethnicity.

CONCLUSIONS: Lower 25(OH)D concentrations were associated with lower SHBG levels and higher free testosterone levels in both men and women, and lower estradiol and higher DHEA levels in women, independent of adiposity and lifestyle. We observed no significant association of 25(OH)D with total testosterone in men. Future studies are needed to determine whether vitamin D supplementation influences sex hormone levels.

Vitamin D deficiency is independently associated with greater prevalence of erectile dysfunction: The National Health and Nutrition Examination Survey (NHANES) 2001-2004

Vitamin D deficiency is independently associated with greater prevalence of erectile dysfunction: The National Health and Nutrition Examination Survey (NHANES) 2001-2004

BACKGROUND AND AIMS: Erectile dysfunction (ED) and atherosclerotic cardiovascular disease (ASCVD) share many common risk factors, and vascular ED is a marker for increased ASCVD risk. Low 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with increased ASCVD risk, but less is known regarding the relationship of low 25(OH)D with ED. We determined whether 25(OH)D deficiency is associated with ED independent of ASCVD risk factors.

METHODS: We performed cross-sectional analyses of 3390 men aged ≥20 years free of ASCVD who participated in NHANES 2001-2004. Serum 25(OH)D was measured by the DiaSorin radioimmunoassay; deficiency was defined as levels

RESULTS: After accounting for NHANES sampling, the weighted prevalence of 25(OH)D deficiency and of ED were 30% and 15.2%, respectively. 25(OH)D levels were lower in men with vs. those without ED (mean 22.8 vs 24.3 ng/mL, respectively; p = 0.0005). After adjusting for lifestyle variables, comorbidities, and medication use, men with 25(OH)D deficiency had a higher prevalence of ED compared to those with levels ≥30 ng/ml (Prevalence Ratio 1.30, 95% CI 1.08-1.57).

CONCLUSION: In this cross-sectional analysis of a representative sample of U.S. men, vitamin D deficiency was associated with an increased prevalence of ED independent of ASCVD risk factors. Additional research is needed to evaluate whether treating vitamin D deficiency improves erectile function.

Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA)

Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA)

BACKGROUND: The association between subclinical cardiovascular disease and subsequent development of erectile dysfunction (ED) remains poorly described.

HYPOTHESIS: Among multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium (CAC) score best predicts ED.

METHODS: After excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima-media thickness, carotid plaque, ankle-brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow-mediated dilation) and ED symptoms at follow-up.

RESULTS: Mean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow-up. Compared with symptom-free individuals, participants with ED had higher baseline prevalence of CAC score >100 (36.4% vs 17.2%), carotid intima-media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility 100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score ≥2 (odds ratio: 1.33, 95% confidence interval: 1.02-1.73) were significantly associated with ED.

CONCLUSIONS: Subclinical vascular disease is common in men who later self-report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED.