4 ways testosterone and erectile function connect to your heart health

Men's Health

by Baylor Scott & White Health

Jul 3, 2024

Testosterone plays an important role in every man’s body. Your levels of this hormone can affect everything from libido to bone health to muscle development. But many men aren’t aware of how low testosterone and another common men’s condition—erectile dysfunction (ED)—are linked to their heart health.

4 ways testosterone and erectile function connect to your heart health

Whether you have low testosterone, are considering taking testosterone replacement therapy or are looking for the cause of ED, here’s what you should know about caring for your heart, too. 

1. Erectile dysfunction is often an early sign of heart disease

It’s common for men to think their ED is caused by low testosterone, but often it’s actually linked to cardiovascular health. When plaque builds up in the walls of your arteries, it not only restricts blood flow in the heart but also penile blood flow, which leads to ED.

“Penile arteries, being smaller than coronary arteries, show symptoms of plaque buildup earlier,” said Anas Hamadeh, MD, an interventional cardiologist on the medical staff at Baylor Scott & White All Saints Medical Center – Fort Worth. “The onset of ED often happens before significant cardiovascular events, providing an early window for cardiovascular risk assessment and intervention.”

One study reported that men with ED have a 40% greater risk of developing cardiovascular events within 10 years compared to men without ED. So, if you have ED, you should talk to your urologist and a cardiologist.

“A comprehensive cardiovascular assessment is recommended when you have erectile dysfunction,” Dr. Hamadeh said. “This includes evaluating traditional risk factors, such as lipid profiles, glucose levels and blood pressure, alongside a thorough clinical exam.”

2. There may be a link between testosterone levels and heart health

More research is needed on how testosterone levels affect your heart. But a recent study showed that men with very low testosterone, called hypogonadism, had higher cardiovascular risks.

To check if you have low testosterone, liquid chromatography is the most accurate measure. For this test, you’ll need to fast and have your blood drawn in the morning, when testosterone levels are at their peak.

There are two types of testosterones in your body:

  • Total testosterone refers to all forms of testosterone in your blood
  • Free testosterone is not attached to any protein in your blood

“If total testosterone or free testosterone is low, you should repeat the test. If you have two tests that are low, either free or total or both, then we may recommend treatment,” said Robert Parham, MD, a urologist on the medical staff at Baylor Scott & White All Saints Medical Center – Fort Worth.

When it comes to high levels of testosterone, men should also use caution. Taking supplemental testosterone that increases your levels too much could affect your heart and overall health. 

“Guys trying to get to testosterone levels of 1,200 or 1,300, that's an issue as well,” Dr. Parham said. “My goal is to keep people above 300 and below 1,000.”

3. If you choose testosterone replacement therapy, check on your heart

If you have low testosterone, you should weigh the benefits and the risks of testosterone hormone therapy (TRT) with your doctor. TRT can improve symptoms like low libido and fatigue, but it could have side effects on fertility, mood and potentially heart health.

Some studies show a slight increase in heart attacks for those who choose testosterone replacement. However, others show the therapy may have a neutral or even beneficial effect on cardiovascular health. Because of this conflicting data, monitoring your heart is important.

“While TRT can offer symptom relief for men with low testosterone, its cardiovascular safety profile requires careful consideration and ongoing surveillance,” Dr. Hamadeh said. “TRT should be used only in men with low testosterone levels confirmed by repeated measurements, and these people should be monitored closely.”

4. Lifestyle changes can boost both urologic and heart health

For testosterone, ED and heart health, lifestyle changes may be your first step to taking control. Diet, exercise and weight loss help keep measures like cholesterol and blood pressure where they should be, and they may also help with ED and regulating testosterone levels.

“First and foremost, I always talk to people about diet and exercise,” Dr. Parham said. “We can jumpstart things by giving testosterone, but if you focus on diet, exercise and good health, you may not need the testosterone.”

Sleep quality is also important to both heart health and testosterone. For example, sleep apnea is known to lower testosterone levels and is a risk factor for heart disease.

“When I see someone with low testosterone and they are overweight or they snore, I tell them to go to their primary care doctor for a sleep study to check for sleep apnea,” Dr. Parham said.

When it comes to caring for both your heart and your urologic health, a team approach is key. With the guidance of your primary care physician and specialists like a urologist and cardiologist, you can create a plan to care for all of your health. Together, you can address any immediate needs, and also set yourself up for long-term wellness.

Your primary care provider can connect you with specialists near you. Find care today.

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