211 Stroke, Testosterone and Heart Attack BioBalance Healthcast Dr. Kathy Maupin and Brett Newcomb Published: November 24, 2014

Transcription

1 211 Stroke, Testosterone and Heart Attack BioBalance Healthcast Dr. Kathy Maupin and Brett Newcomb Published: November 24, 2014 Brett Newcomb: Dr. Maupin and I have been doing these for a little over 2 years now on a weekly basis, and we started doing them because we were writing a book together, The Secret Female Hormone, which has now been published by Hay House and hopefully you have your copy already. But in the process of doing them with that sort of tightly scripted focus, we discovered that too many ongoing things were interrupting our focus. There were events in the news. There were articles that came out that took medicine in a different direction. Kathy's sort of like a flea on a griddle. Her mind just jumps from topic to topic to topic. Dr. Kathy Maupin: That's not very attractive. Well, but you have... That's how my mind works, not my body. Your mind works that way, and I think it's attractive, because I think it's fun to try to follow the flea. But she's always sending me these articles to read to prepare for our discussions on camera. She sent me one this week. I don't know if you have been following the news out in the world the way we follow it for this narrow topic. But there have been articles claiming that testosterone replacement leads to or contributes to cardiovascular problems, heart attacks, and death. Strokes. If you've been given testosterone as a replacement hormone that you might be at risk for that, and get in touch with your local attorney because they're building these databases for lawsuits. We've done a couple podcasts about those. We've talked about some research by Abraham Morgentaler at Harvard, and what those conclusions are. But Kathy found an article in the Journal of Endocrinology assessing all of the various research data that they've been able to find tying testosterone to cardiovascular events and issues. She sent it to me. I read it, and I'm somewhat knowledgeable about these things, because we've been working for a couple years on this. But there was a lot in this article that, as I read I just went glazed over and said, "Huh?" So I thought I would ask her on camera, talk to me like a third grader and explain this stuff to me, and maybe it would be of interest to those of you who follow our show. Need Help? mailto:support@rev.com

2 Hopefully we won't lose you in the reading of the medical terms. But I'll translate it. Okay, so this week she's going to translate for me. These are items that I pulled, sentences, paragraphs, fragments of data, from this article in the Journal of Endocrinology called Beneficial and Adverse Effects of Testosterone on the Cardiovascular System of Men. That's what it looks like. Please don't think we're making these up. Which in an of itself is a mouthful, and it's limited to the study of men. There are studies in Europe that look at testosterone in women, too. But these all look at testosterone in men. I think partly the reason for this, and I don't know. This is my own opinion. Has to do with the study that Dr. Morgentaler referenced in his articles recently about the study that was done in elderly veterans, male veterans, who had a history of a heart attack. Who were in the hospital. Who were in the hospital, and who were given testosterone. And then some of them had additional heart attacks. And strokes. And some of those died. So the headline came out, "Testosterone causes heart attack and stroke in elderly men." And the lawyers jumped right on that. Dr. Morgentaler, and 65 other professionals around the world. Specialists, experts. Immediately began to say, "You need to pull this article. This is not what the data shows. This is wrong. The headline is misleading. The information is wrong. The subgroup that was studied is too limited and restricted." That was from the Journal of the AMA. Journal of the AMA, which almost never pulls anything back. But at any rate, this article then may include that data, but it includes all of the research that's been done on men. 211 Page 2 of 13

3 Between, what is it, 1970 and 2013, every article that's been done on low testosterone and men and heart disease and stroke. And cardiovascular disease. Right. And then they took all that and collated it. That's a lot of research and a lot of patients. Right. So this is good information. So go right ahead. The first paragraph that I read. In leagalese, I mean in medicalese. Says low T, low testosterone, has been linked to increased blood pressure, dyslipidemia, atherosclerosis, arrhythmia, thrombosis, and endothelial dysfunction, as well as impaired left ventricular function. Okay. Say what? Yeah, that's exactly what you said. Translation is, low testosterone has been linked to increased blood pressure, high cholesterol, not high triglycerides, high cholesterol. So when you say low testosterone, part of what you've always said is, as you age your testosterone production decreases. So as you get older, you're going to have lower testosterone. We'll talk in a few minutes about the difference between bound testosterone and free testosterone and total testosterone. But as you get older you're going to have less. So this is saying, as you get older and you have less testosterone, then there's a positive correlation between that lesser testosterone and in increased cardiovascular systemic problems. Right. And high cholesterol. Atherosclerosis is just hardening of the arteries. Arrhythmias, which is an abnormal heart rate. Thrombosis, which is blood clots. Endothelial dysfunction, which is inflammation, like inflammation throughout your body. In the heart, in the blood vessels. 211 Page 3 of 13

4 In the blood vessels. As well as heart failure. The left ventricular dysfunction means heart failure. So if you have a low T, all of these things, you are much more at risk of having if you have low T, than if you have normal testosterone. So anecdotally then, that would suggest that if you restored the T to a clinical level, whatever that might be, normal or not, because there are arguments about dosage among physicians, that would reduce the risk of heart problems? And there are many studies that show that, and they've shown that as well. But in my research, I've found that it depends on what type of testosterone you use. Okay, tell me what you mean by that. Meaning if you use a... Cream. An oral gel, cream, those are usually, they make a lot of estrogen, and it talks about that here. They make a lot of estrogen, so they're not as helpful for heart disease and to prevent heart disease and to prevent stroke. However, shots, and if you took pure testosterone, you have to do it daily. Usually they give not bioidentical testosterone as a shot, called depo-testosterone. That is a little better. It makes less estrogen. And then testosterone pellets, which is why I use testosterone pellets, actually has the least amount of estrogen made, and suppresses the production of estrogen. So the kind of testosterone you use does matter. Estrogen's a female hormone. And men have female hormones, and they have more female hormone. Yeah, it actually does kind of make them feel like they're emotional. I'm getting hot and flustered. I have some guys come in and go, "I've never cried in front of movies, and now I'm crying, and it's just ridiculous." That's a high estrogen. Seriously, it changes your personality a lot. In any case... Makes you more sensitive. Yeah. It does. It mellows you as you get older. But it's not good for your heart or your brain to be mellow like that with estrogen. So basically, choose wisely. But they're not even making any distinctions here. They're just saying all testosterone that was given to men with low testosterone decreased their risk of 211 Page 4 of 13

5 heart disease, and decreased their risk of heart failure, high blood pressure, and high cholesterol. All of those things get better. Are you going to want to translate all this stuff? Because some of this stuff is... Well, I think you can... This is what we read and we translate in our head. That we talk to each other about all together. But I think maybe sort of a summary translation would be beneficial. Next paragraph that I wanted to ask you about. It says, "A modest association is suggested between low endogenous T..." Meaning somebody who has low testosterone all by himself. He makes low testosterone. Okay. "And incident cardiovascular disease or cardiovascular mortality, implying unrecognized beneficial testosterone effects, residual confounding, or relationship with health status." So what does that mean exactly? It means that they've found a, I guess the word for modest is, not everybody does this, but most people who have low testosterone will have a higher amount of heart disease and they'll have a higher rate of death from heart disease. Mortality from heart disease. Because they have low testosterone. That implies, that means they haven't really studied it in the studies that they looked at, although there's a lot of studies from Europe that have looked at this, that it has beneficial effects for the things that cause heart disease, inflammation and high cholesterol. They're also pointing out in the article again and again the distinctions between correlation and causation. They're identifying correlative data. This is down and this is up. And not causative data, this being down made this go up. For you to have a causative data, you have to have every step of the process figured out. Meaning, I have to know how this happened. Well, I can put those pieces together from the research from Europe, and some of the other research that I've collected. I know how it works and why it works this way. All I can tell you is, I could describe those and you'd go to sleep. So all I can say is there is data on the mechanism of how low testosterone increases cholesterol, increases heart disease, and increases death from heart disease. So they have the mechanisms. They did not look into that in this study. They just said it works. 211 Page 5 of 13

6 I think it's relevant to make this point again. You in your work... We've talked before about how doctors compartmentalize in their training, and they overfocus on just 1 element of the type of medicine or practice and patients they want to see. And knowledge that's available and common knowledge in other specialized fields doesn't very often overlap. It doesn't. And you have made a study of those overlaps that have to do with hormones, and in particular testosterone. I've tried to. But it's kind of hard to find that. It is, which is why you read the Journal of Endocrinology for your work in men, even though you're a gynecologist. That's right. And I'll read psychiatric journals and family practice. I just found a bunch of research... Well, yeah, because she said, if I'm going to work with men I need to learn about psychiatry. No. I just think there's a lot about testosterone and hormones, endocrinology that affects depression. Depression, anxiety, panic. Yes, absolutely. There's a lot of crossover. In the endocrinology world, there's a lot of other specialties that do come into it, but I'm not sure it gets back out to those specialties. So I'm kind of making it my mission to get the information out so that you can talk to your neurologist or your psychiatrist about treating some things with just replacing hormones. Well, as you've often said, in gynecology and obstetrics, there's not a specialized bracket for women between 40 and 70. Yeah, there isn't. That's trained to know their issues and their problems, as opposed to women globally. Training in the '70s and '80s, take their uterus out and give them Premarin. That was it. That was basically my training. Everything else was about pregnancy or about young women and periods and birth control. And maybe infertility. But 211 Page 6 of 13

7 that pretty much was my limit. I think they've increased it a little bit, but not much. People coming out still don't really know what to do with women between 40 on. There is no specialty for us. So that's what I've kind of, I'm trying to make out of... Your own specialty. My own specialty. As a specialist, looking at some of these other statements from this article, they say, "dihydrotestosterone slightly decreased systolic blood pressure in healthy men." So I'm curious about dihydrotestosterone, DHT, and systolic versus diastolic blood pressures. What are those? Dihydrotestosterone, some people call it DHT, is a byproduct of testosterone. So in general, if you have, especially in men, if you have a high testosterone, you're going to have a high DHT. There's a few men I've treated that just don't make that jump. Conversion, yeah. And DHT's really important. DHT helps your blood pressure, but it also crosses your blood-brain barrier into your brain and it improves your mood, and it improves neurotransmitters. So it also makes your muscles bigger. It helps you make the muscles bigger. DHT is an important byproduct, not one that you want to have too high or too low. So it's important to keep it in those ranges, and that's what I do with my patients. DHT should be in the proper range so that you can get these benefits. So it's not just giving testosterone. It's watching the byproducts of testosterone, the things that it's broken down into, so that you can keep your, I can keep all my male patients healthy. So one of those benefits, they're saying, is improved systolic pressure. Right. Systolic is the top number. On blood pressure charts. On your blood pressure, and diastolic is the lower number. The diastolic is just a baseline blood pressure in your blood vessels. And at rest blood pressure. At rest, your heart's at rest. 211 Page 7 of 13

8 Right. When it isn't currently beating, or convulsing. When it's not contracting, and it's not pushing blood out of your heart, that's your diastolic blood pressure. When your heart is contracting, that's your systolic blood pressure. So it's your pulse, literally. It's your pulse rate, that pulse of those contractions is the systolic presence. And an adequate amount of DHT improves the pulse. Decreases. Decreases the... Basically the way it does it, it relaxes the blood vessels. So if your blood vessels are really tight your blood pressure goes up. If they're relaxed, then your blood pressure stays normal. So what happens as we get older is testosterone drops, or we make a lot of goo in our vessels. They get stiff, and they get covered with plaque, and they can't dilate, and then our blood pressure goes up. So testosterone... And then the heart has to pump harder. Harder. Which means you might have a stroke or a heart attack. Well, yeah. That's the end point, but... But you're building toward that. But there's a lot... Yeah, you're building toward that. It's like adding rocks to your backpack. Eventually you get so much weight you can't do it. I never thought of it that way, but you're right. It's better to handle it right away. But if you replace your testosterone, then that drops your systolic blood pressure. So that's a great benefit to your heart, and it's a great benefit to the rest of your body actually. It's a great benefit for people who don't want to have ED. Because the systolic blood pressure coming down some, not too low, but some, usually means the blood vessels are dilating, and then there we go. And that's vaso-... Dilation. Dilation in a very intriguing and important part of your anatomy. 211 Page 8 of 13

9 That's right. Makes you more sensitive. You want to be able to make it work. Makes you more sensitive to nitric oxide, which is what's produced... The primary ingredient in Viagra. In Viagra. And drugs like Viagra, other brand names. So tied to that, there's a statement that says "long term oral supplementation administration of testosterone was reported to improve brachial artery vasoreactivity in men with coronary artery disease." All that means is... If you give them testosterone. This is your brachial artery, and coming into your chest. So the brachial artery they studied that. That doesn't mean it's the only artery. They found that in men with heart disease normally you don't get a lot of dilation. If you give them testosterone back, you get dilation. It dilates, meaning it gives you a lot more oxygen to your brain and to your heart. So they study that, because that's one of the symptoms that men have learned to recognize, and doctors have learned to recognize when a man's having a heart attack. That's true. Which is different from women, we found in another podcast and research that we were doing. I don't think that's why they studied it. They could get to it. Well, okay. They could get to it and it wounldn't... Serendipity. 211 Page 9 of 13

10 So that vessel looks like the vessel that goes to your brain and the one that's in your chest. They could get to that artery. So they just specify that's the artery because they don't want to over-... Claim. Claim that it happens to everyone. But basically, they're just looking at this as a window into arteries. Okay. All right. So it just means everywhere testosterone dilated the blood vessels. So sidebar. Then one of the things about this research all being focused on men is that reference, because they found that women manifest heart attack onset differently, not through that symptomology. We have different symptoms. We usually don't feel the elephant on our chest, like men say. Usually we get pain in the jaw. We can get pain in the shoulder and the back. It's just a different presentation, and one that people don't recognize in the ER. So they're much better at it now than they were 2 years ago when we first talked about it, thank goodness. "Most T in circulation is bound to plasma proteins, 97% to 99% of your testosterone is bound testosterone, which means it's attached to a plasma protein that's circulated through your blood. The rest is free testosterone." What is free testosterone, and why does it matter?" I explain this all day long. I kind of love to explain this. Your testosterone is bound to a protein to inactivate it. So just visualize testosterone like you've got a gumdrop that has a little area that's going to stick to something. So that area is open and it's ready to stick. Instead of that gumdrop sticking to the surface, we put something over it so it's not sticky anymore. So it can't stick. The plasma protein covers the area on the testosterone that would normally attach to cells and activate it. So everything that is in your body that is bound to a protein, every testosterone that's bound to a protein, is not active. It cannot work. It's completely inactive. The total testosterone doesn't really matter as much as the free testosterone. So free of binding means it's active. So your testosterone then, when we look at total and free, there's a couple things to remember. Total testosterone in general, I like to think of a pie chart, is a big circle when we're young. A bigger circle in men than women. It has a percentage or a big slice of pie that is free testosterone, or active. As we get older, the circle gets smaller for men. For women it just disappears. But as we 211 Page 10 of 13

11 get older it gets smaller, and that piece of pie, instead of being wide, a big percentage of it, it gets really narrow. Well I can fix the total, but I can't make that percentage get bigger. So as we get older, even if we replace the testosterone, you have to go to somebody who knows how to give you enough testosterone so that slice of pie is actually the same amount of free testosterone as you had when you were younger. And that's one of the hot button issues in the topic of replacing hormones, and particular replacing testosterone. Testosterone, right. Is what's the appropriate dosage. Do you restore to normal, whatever normal is, for men of a given age? Or do you restore to the point of functionality? Well, most of the time, if you restore to normal young testosterone levels, and you're older, you're not going to have enough free to feel good. So I have to go over. Beyond what was normal. I have to go beyond, and then I will get enough of the active form for somebody to feel well. And so a lot of doctors don't know what you know, because they haven't done the specialized work. And if I wander into my regular physician's office and he tests my testosterone, he'll be shocked and say, "This is a problem because it'll make you have a heart attack." No, he won't know that. No, he won't know that. He hasn't read this. Endocrinologists read this. They're not cardiologists. So why would he be concerned, other than the fact that it's high on the levels. Oh, well, because we've already shown that it doesn't cause heart attacks. Right. We've already shown that it protects from heart attacks. 211 Page 11 of 13

12 Right, we know that. We know that. He's going to worry about prostate. But your prostate's not seeing the total testosterone either. It's invisible. All it's seeing is the free testosterone. So we have a couple problems here. Education or thought process through the physiology of this hormone. For the doctors. For the doctors. And we have another problem. On the lab tests, they don't have even a normal total that is functional. Four hundred is the magic number, 400 to 1,200 is a normal amount of total testosterone, and free testosterone should be 129 or above. So if you don't have a free testosterone of 129, you're not going to feel right. Most lab tests say 30 to 100, or something like that, something that is not functional. They're giving you the average for your age, or age adjusted. They're not giving you what's normal and healthy for you. For feeling good. So we have several problems here. We have a lab problem. We have an education for doctors problem. I'm not sure that that's going to get fixed too soon. And we have people looking at the wrong number. They're not looking at the... The free testosterone is really, if I could have one test, that would be the only test I'd do. Right. Because if you have enough free testosterone, then I don't need to treat you. You're protected from all of these things. Your healthy, and you should be functional. If you're not functional and you have a great free testosterone, then I look for other things, diabetes, or problems with the vasculature. You've already had problems with your vessels. So to wrap this up, we've been talking about a complex article in a specialized medical journal that gives lots of terminology and data that doctors know, but ordinary people don't. Or should know. Should know. Basically, the end of the article summary is that testosterone doesn't cause heart attacks. It may actually prevent them. Right. 211 Page 12 of 13

13 If you have the right amount. And stroke. So the question is, how to get the right amount. As Kathy was just explaining, doctors don't have that education and information. The lab tests don't have that education and information. She does, because she's really worked hard to acquire it. She's done what Albert Schweitzer said many years ago. "It's better to light a single candle than to curse the darkness." And she's gone about lighting all these candles, and saving lives and improving the quality of life. So if you have concern about these issues, find a physician like Kathy who specializes in acquiring this information and the ability to provide this procedure, or come to Kathy. Yeah, I'd be glad to see you. Thank you for listening. How did we do? Rate your transcript 211 Page 13 of 13