"...do you think that perhaps patients with CHF, type 2 diabetes, obesity, etc have low testosterone because they're in a general poor state of health?"
In its introduction, the article I referenced from the Journal of the American Heart Association (Nov 2013) specifically refers to this same question:
"Testosterone in men reaches maximum levels at approximately age 30, after which levels steadily decline at a rate of 1% to 2% annually. Controversy exists regarding whether the decline in testosterone with increasing age is a normal physiologic process or whether it is a result of chronic comorbidities and lifestyle choices. Testosterone levels are lower in patients with chronic illnesses such as end-stage renal disease, human immunodeficiency virus, chronic obstructive pulmonary disease, type 2 diabetes mellitus (T2DM), obesity, and several genetic conditions... It is unknown whether low testosterone in patients who are ill is the cause of their illness or whether it is caused by their disease."
After its review of more than 100 studies that relate to this question, the article went on to conclude:
"This review article has demonstrated that normal testosterone levels play an important role in maintaining cardiovascular health, and testosterone replacement therapy in men with hypogonadism improves obesity, T2DM, myocardial ischemia, exercise capacity, and QTc length. Current guidelines from the Endocrine Society make no recommendations on whether patients with heart disease should be screened for hypogonadism and do not recommend supplementing patients with heart disease to improve survival. Longitudinal, placebo-controlled, randomized trials of testosterone replacement therapy in men with low testosterone levels are required to completely clarify the role of testosterone in survival of patients with heart disease."
To repeat: "testosterone replacement therapy in men with hypogonadism improves obesity, T2DM, myocardial ischemia, exercise capacity, and QTc length"
In case you are unaware, myocardial ischemia and irregular QTc lengths are both associated with increased rates of heart disease.
The article's conclusion could therefore be reworded to say: testosterone replacement therapy in men with hypogonadism improves several factors that are directly associated with increased rates of heart disease.
In my comments about this article, I stated simply that:
"Testosterone deficiency is associated with increased rates of heart disease.
Therefore...
Properly managed testosterone replacement therapy should be associated with decreased rates of heart disease."
In view of the above, I do not think that I have misinterpreted this article.
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