Low testosterone can cause depression and even lead to anxiety over time. Can low testosterone contribute to anxiety or depression? Low testosterone often causes irritability, mood swings, and ongoing sadness or anxiety. What emotional symptoms are linked to low testosterone? Further work will undoubtedly expand our knowledge regarding the underlying mechanisms and relationships between low testosterone and coronary disease and this will be of great interest. Studies in male animals have shown accelerated atherosclerosis after castration—an effect that is abrogated by androgen replacement therapy.43, 44 The prevalence of hypogonadism in men with asymptomatic coronary plaque is similar to the prevalence in men with symptomatic CAD and both groups have lower levels of testosterone than men with normal coronary arteries, supporting a causative role more than a symptomatic consequence (Morris PD, 2001. unpublished data). Like resistance training, cardio causes short-lived testosterone surges during exertion and for up to 60 minutes after finishing a workout. But what does scientific research actually demonstrate regarding different cardio modalities and their effects on testosterone metabolism? It’s often assumed that cardio exercise like jogging, cycling and metabolic conditioning spikes testosterone production. Factors such as age, diet, sleep quality, and stress can all influence testosterone levels. However, as fitness levels increase, the hormonal response to exercise may diminish, highlighting the need for progressively challenging workouts. And not all exercise is equal when it comes to increasing testosterone. Studies have shown that exercising does increase Testosterone Levels-but not all exercises are created equal. Her passion is to transform health through both traditional and alternative medicine with a focus on finding the root cause of disease. So, if you ever have any doubts about the beneficial properties of exercise, then think about the benefits it can offer your sex hormones. Decrease blood pressure – Better stamina and heart health go hand in hand. Does Exercise Increase Testosterone Levels? Androgenic steroids can serve as appearance and performance-enhancing drugs and are abused by some competitive athletes, recreational sportspersons and body builders (1,215,216). Bearing in mind the limitations of these retrospective, observational and non-randomized studies, which cannot prove causality, the available data provide some reassurance but are far from definitive. In a study by Cheetham et al. (2017) of men aged ≥40 years diagnosed with low T or with T 205). A single measurement of testosterone on a particular day, may not be an accurate reflection of testosterone concentrations achieved over sustained periods of time with different testosterone formulations (211). An interesting distinction was made in the studies by Sharma et al. (2015) and Andersen et al. (2016) in that men who were prescribed T who then had “normal” T concentrations, did better than men who had persistently low T concentrations or who did not receive T (202,203). Hypertrophied cardiomyocytes increase glycolysis-dependent ATP production, and glucose uptake is stimulated by testosterone, which involves the participation of the CaMKII and AMPK signaling pathways.42 The effects of gender and reproductive hormones on cardiac mass have led to the hypothesis that testosterone influences human left ventricular hypertrophy. There was a weak correlation between free testosterone levels and 6-min walking test (6MWT) distance. The free testosterone level was within the normal range, and there was no association between free testosterone levels and LVEF, NT-proBNP levels, or high-sensitivity C-reactive protein (hsCRP) levels. Hone is an online clinic that helps men and women manage their health. Research-backed tools, tactics, and techniques to maximize your health, delivered to your inbox every Monday. Korey also specializes in nutrition research, personal training, and writing; and hosts The Performance Connection podcast. Learn what it takes to boost energy, maintain strength, and stay healthy longer—delivered to your inbox every Monday. “Chronic fatigue that is disproportionate to training load is a common symptom of LEA-driven hormonal suppression,” Kraus says. The quality of the studies will be assessed by 2 independent reviewers following the Cochrane Collaboration’s tool for assessing risk of bias. In addition, the limiters will be human studies, studies done on males, publications written in English, and publication year set to range from 1980 to 2019 and when available, and peer-reviewed randomized controlled trials. Search terms will include testosterone AND (cardiac OR heart OR stroke OR myocardial infarction OR atherosclerosis OR revascularization OR Agatston score OR death OR angina OR carotid OR artery OR coronary OR cerebral OR aortic OR peripheral vascular) anywhere in the text by using truncation and wildcards when available, to accommodate for different spellings. Experimental studies with no randomization (such as quasi-experimental studies) will not be included in this study. In a study of 2078 men who were referred for coronary angiography, Wehr et al discovered an independent association between low levels of free testosterone and CHF mortality.138 Wehr reported the hazard ratio for CHF mortality in the fourth compared with the first quartile of free testosterone to be 0.38 (95% CI, 0.17 to 0.87). Finally, Jankowska et al demonstrated that reduced levels of total and estimated free testosterone were both predictors of increased mortality in men with CHF.137 Similar findings have been reported by other investigators as well. To the best of our knowledge, there are no published studies that evaluate the effects of testosterone replacement therapy on IMT. Again, Hak et al did not find a significant association between testosterone levels and progression of atherosclerosis in the female abdominal aorta.133 Demirbag et al performed similar analysis on 42 men, but instead investigated the association between testosterone and thoracic aorta IMT.134 Demirbag et al discovered an inverse association between total testosterone and thoracic aorta IMT.134 BMI indicates body mass index; BP, blood pressure; CCS, case–control study; CS, cross‐sectional study; FT, free testosterone; IMT, intima‐media thickness; SHBG, sex hormone–binding globulin; TT, total testosterone. These findings suggest that testosterone increases inward Ca2+ currents and that this effect is attenuated by GDX.These workouts are usually shorter than traditional cardio, but way more physically and mentally challenging.Studies show that men who work out regularly have significantly higher testosterone compared to couch potatoes.In females, testosterone plays a role in ovarian function and sex drive, but to a much lesser degree, and is made in much smaller amounts.From our search, we discarded any studies that were not relevant from the title or abstract and read the remaining to identify placebo-controlled randomized trials of statins with testosterone reported.Long-distance running or high-volume cycling has been linked to lower testosterone levels, possibly due to prolonged stress and increased cortisol.Moving to your upper body, the bench press again hits a wide range of muscles.Slow and steady workouts do not produce the necessary increases in testosterone production. Moreover, the change in QTc interval after logarithmic transformation of total testosterone values was calculated to be −8.1 ms. However, it should be noted that although the same trend was observed by van Noord et al, statistical significance was not achieved when analyzing each population‐based study separately. On the other hand, the studies that failed to find an association between testosterone and CRP used an older population group. Given the conflicting evidence regarding the association between levels of endogenous testosterone and hsCRP, no conclusion can be made on this matter. Although several authors have discovered statistically significant negative associations between levels of endogenous testosterone and CRP,46,92–96 others have failed to demonstrate any association between testosterone and CRP levels.84,97–99 These authors have investigated a possible association between levels of testosterone and markers of inflammation. Effects might differ in settings, such as China, where peak testosterone 37,54, androgen related parameters 55,56 and ischemic heart diseases mortality rates are all lower than in western populations. This meta-analysis also raises the question as to whether lowering testosterone is a side effect of statin therapy or contributes to statins' mode of action, which could inform new treatments and prevention policies. We could not identify any RCT confirming testosterone therapy increases diabetes incidence among women. Statins lowered testosterone by about 12.3% among women (-0.40 nmol/l, 95% CI -0.05 to -0.75) in a random effects model, with similar results when the most extreme study was omitted. The orchiectomy plus placebo group had much higher levels of atherosclerosis than all other groups, whereas the TE group had the lowest levels of atherosclerosis.33 This study suggested that testosterone attenuates the formation of atherosclerotic plaque in this rabbit model. In this study, the testosterone level required to reduce atherosclerotic plaque was found to be near physiological levels.32 This effect was not present in males treated with only estradiol and females treated with only testosterone, suggesting that when both hormones are present, the sex‐specific hormone dominates this mechanism and protects the vasculature from the buildup of atherosclerotic plaque.31 The estradiol plus testosterone treatment inhibited plaque build up in both sexes compared with the control groups. Because the male sex is believed to be a risk factor for atherosclerosis, investigation of the relationship between testosterone and atherosclerosis has been explored.30 Bruck et al31 noticed differing results in the literature and thus tested the relationship between testosterone and atherosclerosis in a rabbit model. When hormones settle into that new and better balance, a host of negative symptoms may improve. If you’re a seasoned weight lifter, 60–120 minutes of weightlifting might be exactly what your body needs. If you’re getting back into weightlifting after a few months (or years) away and you haven’t been doing any sort of home fitness routines for a while, 15 minutes might be the most your body can handle. The basic premise of HIIT is that, instead of exercising steadily for the entire time, you exercise as hard as you can for a short period (30-60 seconds or so) and then take it easy for about a minute or two. Stature was measured to the nearest 0.1 cm using a stadiometer (Seca, Birmingham, UK), and body mass and body composition were determined by a multi-frequency bioelectrical impedance analyzer (BIA (Tanita MC-180MA Body Composition Analyzer, Tanita UK Ltd.)). Sessions were conducted in groups of between four and six participants and were the sole exercise performed during this time. To account for the contribution of conditioning exercise and HIIT, participants were tested at three phases; baseline (phase A), following conditioning exercise (phase B), and post-HIIT (phase C) using identical methods. Some cross-sectional studies conducted in middle-aged and older men indicate that circulating testosterone concentrations may be higher in men who regularly exercise (3,40). Rather than administering pharmacologic doses of exogenous testosterone, interventions that favorably alter endogenous sex hormone levels could be of greater benefit in this setting. Yet, there is some evidence that increasing sex hormone levels in aging men may provide health benefits such as improved cognition, enhanced sexual function, and reduced frailty (28). Publication types As a consequence, some studies of the effect of androgens on the cardiovascular system use the non-aromatizable androgen DHT, rather than testosterone or its derivatives, for example 38-40. As advanced age is a major risk factor for the development of cardiovascular disease in both sexes, the incidence and prevalence of these diseases is expected to escalate as our population ages . The knowledge that receptors for all major sex steroid hormones, including testosterone, are present on individual cardiomyocytes suggests that these hormones may influence the heart at the cellular level. Although this review is focused primarily on the role of testosterone in men, possible differential effects of the hormone in women must be considered in future studies. Given the correlation of physical activity with various cardiovascular risk factors, it is unclear whether any observed associations with testosterone level are directly or indirectly mediated by one or more of the risk factors. We also know that regular exercise, along with a healthy diet, can help with maintaining a healthy body weight. We don’t understand the mechanism clearly, but we know certain types of exercise can cause a small increase in testosterone. The short answer is that it’s relatively difficult to increase testosterone substantially through exercise. Certain medical treatments, such as chemotherapy, can also decrease testosterone production. Nevertheless, amateur workouts of different structures, i.e., weekly training volume, session intensity, and the work-to-rest ratio during repeated exercises also cause different biological responses. It seems that men who undertake moderate physical activity at leisure to achieve better physical fitness and health status are not at such high risk. A significant decrease in the T/C index indicates that the training activity is too high and catabolic processes prevail, which, in extreme cases, may lead to a decrease in skeletal muscle mass. As cortisol and testosterone have opposing effects on the rate of endogenous protein metabolism, the idea has emerged to assess the anabolic–catabolic balance as an index of the quotient of molar concentrations (T/C) 22,23. This plan includes just the right amount of cardio and resistance training to build muscle and boost testosterone. A smart approach includes weight training with enough cardio to support heart health. A mix of high cortisol, lack of rest, and excessive endurance training can keep testosterone levels suppressed. When treated with SNP, the testosterone group had a significantly lower relaxation percentage than did the controls at testosterone concentrations ≥10−6 mol/L.40 These findings suggest that testosterone attenuates dilation and intensifies constriction of the blood vessels. When treated with 5‐HT, aortas from the testosterone group displayed statistically significantly higher contraction percentages than those from the control group. In contrast, no proatherosclerotic genes were upregulated in macrophages from female donors. Application to Clinical Practice Instead, incorporating a well-rounded fitness routine that includes resistance training and HIIT can lead to more significant and lasting improvements in testosterone levels. Interestingly, those who are less physically fit may experience more significant improvements in testosterone levels when they begin exercising compared to those who are already in good shape. Our body composition and fitness levels are essential factors that impact how exercise affects testosterone production. To allow for the comparison of HIIT with participants’ normal training regimens, the study necessitated three distinct assessment phases (phase A, B and C), each lasting one week, which were separated by six weeks. One of the most important articles on HIIT exercise (20) highlighted the lack of HIIT studies in aging cohorts. Moreover, HIIT increased PPO, but decreased TT and free-T in young trained participants (19). Subsequently, we observed increased free-T following the addition of HIIT to this group (13). Studies almost invariably adjusted for age, and typically adjusted for BMI and other cardiovascular risk factors. UK Biobank used an immunoassay for measurement of serum T which may underestimate results compared to mass spectrometry (70), and UK Biobank men were generally healthier than the UK male population as a whole (71). In one study, men with lower total T had a higher risk of heart failure, but this was not confirmed in another study (65,68). One smaller study reported a U-shaped association of total T with incidence of cardiovascular events (54). This is illustrated by observational studies which show a reduction in cardiovascular events and mortality following bariatric surgery in patients who are obese (mean age 48 years) (41,42). At present, the hormone does not appear linked to hypertension or inflammatory markers. That's one of the things that gave testosterone its bad reputation. In high doses, androgens tend to raise LDL ("bad") cholesterol levels and lower HDL cholesterol levels. In contrast, high cortisol levels were recorded during volatile, up-and-down trading sessions. They found that a high testosterone level in the morning was linked to a successful, money-making trading day. Before you get into your compound movements, you want to warm up your muscles. Lower body compounds include body weight squats, weight squats, lunges, and reverse lunges. Upper body push includes push-ups, chest presses, ring dips, and shoulder presses. In addition, a significant increase in the rate of myocardial infarction, stroke, sudden cardiac death, and development of cardiovascular disease was noted in patients receiving antiandrogen therapy.67Participants completed a maximal graded treadmill test, with heart rate and oxygen uptake continuously monitored by a Medgraphics automated metabolic cart (Medgraphics, St. Paul, MN).There are no large long-term, placebo-controlled, randomized clinical trials to provide definitive conclusions about TRT and CV risk.Another way exercise could help increase testosterone levels is through weight maintenance.In sensitivity analyses when the gap between the risk and control periods was varied, the conclusions drawn from the resulting effect estimates were essentially unchanged across the different analyses (Table 3).And you may have also heard that levels of this hormone decline with age in people assigned male at birth, with an average dip of about 1 percent every year after age 40, according to Mayo Clinic. Thus, the increase in APD seen following GDX may prolong SR Ca2+ release, increase the duration of contraction, and slow relaxation. Taken together with the DHT work reviewed above, these observations suggest that chronic exposure to testosterone abbreviates the cardiac AP, and in its absence, APD is prolonged. By contrast, there is general agreement that GDX prolongs APD50 39,84 and APD90/95 ( but c.f. ) in both intact ventricular muscle and in isolated ventricular myocytes (Table 2). Thus, apparent prolongation of APD by testosterone may be due to estradiol produced by aromatization. Discover common causes, symptoms, treatment options, and when to seek care for lasting relief. Learn how UTIs in men can affect men’s sexual health and sometimes lead to erectile dysfunction (ED). Then, you’ll be able to schedule a virtual call with the Rex MD care team to further discuss your results, eligibility, and which treatment option would be most suitable for you, if any. Your provider will order lab work for you to help determine if you’re eligible for TRT or another testosterone solution available through the program. Visceral fat can actually raise cortisol and estrogen, which in turn lowers testosterone. Working out helps reduce body fat, especially around the midsection. If you consistently workout to raise T levels, your resting T levels will start to raise methodically and permanently. In fact, research shows that the more frequently men experience this quick T spike, the greater their resting testosterone level. This means that there’s only a short-term spike in testosterone during the day. Rasmussen et al. reported an association between global left ventricular strain and AS use, which was detected by echocardiography and MRI . On the other hand, D'Andrea et al. found left atrial dysfunction with the use of speckle echocardiography in AS users . Also, Nottin et al. found no increase in left ventricular wall thickness but reported decreased left ventricular function in AS users . Cecchi et al. discovered a direct apoptotic cardiac and endothelial change in the heart tissue of deceased patients with heart failure who had a history of AS abuse . Far et al. found cardiac hypertrophy in 88 deceased males who tested positive for AS use . As a result, the brief boost from your exercise session might be even bigger if you schedule it after work instead of early in the morning, Isaacs says.Rettew et al45 investigated toll‐like receptor‐4 (TLR‐4) expression in mice, as TLR‐4 has been shown to mediate various immune responses.46 In this study, macrophages were isolated from orchiectomized, sham‐orchiectomized, and orchiectomized plus testosterone‐replaced mice.BMI, body mass index; Ca, calcium; H, hydrogen; HbA1c, hemoglobin A1c; hs-CRP, high-sensitivity C-reactive protein; K, potassium; O, oxygen; OH, hydroxide; QTc interval, heart-rate–corrected QT interval.In the study (experimental) group, a special training modification was introduced (independent variable), consisting of performing 60 min of personal endurance and strength training.The long-term effects of regular exercise can help keep your testosterone levels in check, especially as you age.However, not all exercises were created equal in their effect on testosterone production, as some workouts may cause your T levels to drop even further.In another study on female embryonic heart H9c2 cells, which express a low number of androgen receptors, testosterone was shown to exert protective effects against 2,4-dinitrophenol, an inhibitor of oxidative phosphorylation.While moderate cardio has positive effects, excessive endurance training has been shown to lower testosterone levels. As we age, maintaining healthy testosterone levels becomes increasingly important. In recent years, research has increasingly focused on how exercise—particularly different forms of exercise—affects testosterone levels. This means that even if cardio might lower testosterone somewhat, it’s not pushing levels to a point that would be alarming or detrimental to health. In some cases, excessively long cardio sessions might even lead to a decrease in testosterone levels. Therefore, the purpose of the present investigation was to examine the influence of HIIT, following moderate aerobic conditioning, on androgen status in previously sedentary older males. Furthermore, significant correlations between testosterone and measures of physical performance in older adults have been observed (9). The precipitous decline in systemic testosterone with age is well described (4). If you’re struggling to put in the fitness work to meet your goals due to chronic fatigue, you might consider the possibility that you’re suffering from low testosterone. To put it simply, you can’t use Testosterone Replacement Therapy as a bodybuilding shortcut. When it comes to TRT, weightlifting is critical if you expect to gain muscle. When you have low testosterone, you’ll have to work much harder in the gym to get the same results you once got with much less work. Research has found that strength-training workouts may have a bigger effect on testosterone in the evening. Of course, exercise has many other well-known health perks. It's not yet clear what health effects, if any, these temporary boosts may have. Based on this study, a mixture of both aerobic and resistance training is most effective in maintaining and increasing healthy testosterone levels. However, cardio exercise does not necessarily harm testosterone levels provided training emphasizes brief, explosive bursts over sustained endurance efforts. In conclusion, while cardio exercises may provide temporary boosts in testosterone levels, they are not the most effective long-term strategy for enhancing hormonal health. Now that we understand the relationship between cardio, exercise, and testosterone levels, let's explore some practical tips to optimize our fitness routines and support hormonal health. A list of studies that analyzed the association between testosterone level and mortality is presented in Table 3. Testosterone may be acting directly on the cardiovascular system by a mechanism that is as yet undiscovered. Ohlsson et al27 performed an analysis of 2416 community‐dwelling Swedish men (MrOS Study) in which they investigated cardiovascular events and event‐free survival. There is growing evidence supporting an inverse relationship between the degree of testosterone deficiency and the severity of coronary artery disease. In contrast, extended, moderate-intensity cardio sessions, like long-distance running or cycling, might not have the same testosterone-boosting effect.Calof et al did not find a significant difference in the rate of cardiovascular events between the testosterone replacement group and the placebo group.146 Specifically, the authors found no statistically significant differences between the 2 groups in the rates of atrial fibrillation, atrial arrhythmia, myocardial infarction, chest pain or ischemia, coronary procedures including coronary artery bypass grafting, vascular events, and cerebrovascular events.What this shows researchers if that more moderate workouts can help your body to level its’ output of these two hormones.The training program was designed so that it was simple to perform and accessible to every participant.Some cross-sectional studies conducted in middle-aged and older men indicate that circulating testosterone concentrations may be higher in men who regularly exercise (3,40).AIndicates that the effect of GDX was reversed by treatment with testosterone in studies by Tsang et al. and Witayavanitkul et al. .Because the male sex is believed to be a risk factor for atherosclerosis, investigation of the relationship between testosterone and atherosclerosis has been explored.30 Bruck et al31 noticed differing results in the literature and thus tested the relationship between testosterone and atherosclerosis in a rabbit model.Bring new energy to your life with our easy-to-use testosterone replacement therapy, right from home. All Types of Exercise Count Staying up late at night actually prevents your body from healing damaged muscle and replenishing testosterone. Reduced stress, in turn, reduces some negative effects on testosterone and other hormones. When it comes to hormonal health, efforts to reduce your stress to manageable levels work in tandem with your exercise goals. Their testosterone levels drop as their cortisol levels rise. Studies have shown that men who exercise regularly tend to have higher testosterone levels compared to those who are sedentary. When you exercise, your body releases testosterone and other anabolic hormones to build muscle and burn fat. So how exactly does moving your body increase testosterone levels? Enhance your regular cardio with high-intensity training (HIIT) and you can definitely see a significant difference in your testosterone health. One of the studies also showed that testosterone levels were low in endurance-trained cyclists and their cortisol levels were measured to be significantly high. That is why HIIT is recommended instead of endurance training if you are working on raising your testosterone levels. Data Extraction We did find a significant increase in the more biologically active androgen, DHT, with exercise in our randomized trial. However, we also did not detect a decrease in testosterone that would be considered deleterious to men’s health. P value testing the difference in change from baseline to 3 months or 12 months in exercisers vs controls, comparing change in % body fat category vs gained % body fat category. Running is primarily an aerobic exercise that emphasizes cardiovascular endurance.Additional research designed to tease out the physiologic mechanisms underlying the effect of exercise on SHBG independent of dietary change is needed.Certainly, a loss of fat mass could explain the greater increase in SHBG seen in exercisers, because this should lower insulin levels and, therefore, reverse the inhibition of SHBG production.Over time, you can increase the amount of strength training while also focusing on different muscle groups on specific days.It remains unclear the roles of AS drug dose and drug duration as it relates to CVD risk.In general, training sessions involving more intensive exercises can help boost testosterone better for example in the case of high-intensity interval training (HIIT).When testosterone levels rise too high, the brain sends signals to the pituitary to reduce production. Raging hormones? In support of this, testosterone has been shown to inhibit phosphodiesterase and increase cAMP levels in rat atria and ventricles . Furthermore, Ca2+ sparks are larger in cardiomyocytes from male animals when compared to females 102,103. The next section reviews studies that have investigated the influence of chronic testosterone withdrawal on specific intracellular Ca2+-handling mechanisms in the heart. One study has shown that testosterone deprivation has no effect on myofilament Ca2+ sensitivity but reduces maximal myofilament responses to Ca2+ in skinned rat ventricular muscle . Likewise, chronic exposure to testosterone (24 h in culture) increases the rate of relaxation in individual rat myocytes , while testosterone withdrawal slows cardiomyocyte relaxation 91,99, as shown in Table 4. Testosterone can be transformed by the enzyme 5α reductase to 5α-dihydrotestosterone (DHT), a more potent androgen with five times more affinity for the androgen receptor and a ten-fold more potent effect on signaling.1 It has been speculated that the conversion of testosterone to DHT is required for regulation of some of the effects of androgen on the cardiovascular system. Naderi et al.99 assessed the levels of several hormones and markers in 33 men with idiopathic dilated cardiomyopathy and NYHA class II-III heart failure. Additionally, in several studies, sST2 levels were found to be significantly elevated in healthy men compared with healthy women. Sex steroid hormones influence viremia and virus localization; in females given exogenous testosterone and progesterone, the amount of virus in the heart is ten times higher than that in animals given estradiol. Despite inconclusive evidence on cardiovascular risk and inconsistencies among clinical practice guidelines, millions of men continue to use testosterone replacement and androgen deprivation therapy. These studies notwithstanding, I think the answer to the question “what's better strength first or cardio first” is more complicated than just looking at testosterone levels. These researchers likewise noted performing endurance exercise first caused higher levels of testosterone after exercise, compared to when strength training was performed first. Soluble ST2 (sST2) levels are elevated in young men with myocarditis and correlate with NYHA class III–IV heart failure. In an in vivo study, male and female BALB/c mice were inoculated with various concentrations of coxsackievirus. Several experimental studies have suggested that testosterone promotes a type of inflammation that may be involved in fibrosis in the setting of myocarditis.75,76,77,78 Myocarditis is a form of inflammatory cardiomyopathy that typically develops secondary to viral infection, often in young, healthy men. Finally, the study by Güder et al.62 is noteworthy because it also included patients with heart failure and preserved ejection fraction. These hypotheses are types of testosterone treatments (oral administration, transdermal application, intramuscular injection or implant vs no testosterone), dosage of testosterone received (total dosage mg received during the duration of the study vs no testosterone), and follow-up period (at least 6 months vs more than 6 months). The number of events regarding primary and secondary outcomes among those who received any testosterone intervention will be compared to that of the control group of usual care or no testosterone intervention and the likelihood of events presented as risk ratios with 95% confidence intervals. The characteristics of the included study and participants will be noted in a table, grouped by the types of testosterone therapy received. The secondary outcome will be any atherosclerotic cardiovascular disease, broadly defined to include events occurring in the coronary, cerebral, aortic, and peripheral vasculature. Serum concentrations of testosterone, free testosterone, dihydrotestosterone (DHT), 3α-androstanediol glucuronide (3α-Diol-G), estradiol, free estradiol, and sex hormone–binding globulin (SHBG) were measured at baseline, 3, and 12 months. The effect of exercise on androgens in middle-aged to older men is poorly understood, and it could have implications for several aspects of health. While a 30-minute jog a few times a week might not significantly lower testosterone—and could even help maintain it—marathon training with high mileage could yield different results. This decline can lead to reduced energy, lower muscle mass, and changes in body composition and mood. Does running increase testosterone, reduce it, or have no significant effect? How long do testosterone levels stay elevated after a workout? For example, elite athletes sometimes show reduced testosterone levels due to extreme training demands. But in women who have an overabundance of testosterone in their bodies (for example, polycystic ovary syndrome), exercise may lower testosterone levels. Studies show that if a sedentary person commits to a HIIT program, base testosterone levels will increase within weeks. High-intensity interval training (HIIT) can generate a temporary spike in testosterone levels that can last up to an hour. Carrying excess body fat, especially around the midsection, is strongly linked to lower testosterone levels. In fact, overtraining can actually backfire and cause your testosterone levels to take a nosedive. That’s how you keep your body adapting and your testosterone levels elevated for the long haul. When you resistance train, your body releases testosterone and other anabolic hormones to help build and repair muscle tissue. Wanna increase your testosterone levels? In men, the decline in sex hormone levels is much more variable appearing to spare some men, fall unknowingly in some, and result in frank and symptomatic hypogonadism in others. Irrespective of regional variations in the prevalence of coronary heart disease, the burden of coronary disease in men is approximately three times that of women.1 Moreover, men develop coronary disease approximately 10 years ahead of women. The results of the study indicate that further research is needed to determine other body responses resulting from the proposed form of physical activity. Typical resistance training improves only neural adaptation, which manifests itself as an increase in strength but does not alter VO2max. If the adrenal cortex responds excessively to training, it is suggested that the intervals be extended between repeated exercises, which allows a reduction of the stress response, i.e., glucocorticoid status, and, at the same time, achieves the planned physical load. This reduction in the rate of SR Ca2+ may explain the slower Ca2+ transient decay 76,99 and reduction in SR Ca2+ content characteristic of cardiomyocytes from GDX animals. As phosphorylation of PLB at both the PKA and CaMKII sites increases the activity of SERCA2a , a reduction in phosphorylation at these sites would be expected to reduce SERCA2a activity. There is also evidence that PLB phosphorylation at the PKA site (Ser16) is reduced by GDX , although this is not seen in all studies . There is good agreement that PLB protein expression is similar in sham-operated and GDX hearts 69,75,76,96. Regular cardiovascular exercise can have a positive impact on testosterone levels, particularly when performed in moderation. These reviews cover epidemiological studies of T and the incidence of cardiovascular events16 and mortality risk,17 RCTs representing mechanistic studies of T and the cardiovascular system,18 T RCTs reporting cardiovascular adverse events,19 and retrospective reviews of T prescription databases.20 These are accompanied by commentaries on the implications for Andrology in the regional context21 and globally for studies of male hormonal contraception.22 Taken together, the content of this Special Issue addresses a pressing debate that affects the care we provide to men with androgen deficiency and future research to preserve health in the expanding population of older men in our communities. First, men who are androgen deficient due to diseases of the hypothalamus, pituitary, and testes should be considered for T-replacement therapy.11 In these men who have hypogonadism due to pathology of the gonadal axis, it is essential to inform and advise them of potential benefits and possible risks of treatment.12 Second, there has been a marked increase in T prescribing worldwide over the past decades, despite the prevalence of pathological hypogonadism remaining relatively stable.13,14 In men who do not have hypothalamic, pituitary, or testicular disease, who are typically older with other medical comorbidities and circulating T that would be regarded as low in younger men, the question arises as to the justification for T treatment and whether potential harms might outweigh anticipated benefits.15 Understanding the extent and the limitations of the existing evidence base would help health practitioners counsel men receiving T treatment for medical indications, may discourage its misuse in men where a medical indication is not clear, and will provide a foundation for future research. The following discussion provides a broad overview of testosterone, and its receptors, including pathways involved in its biosynthesis, regulation, and metabolism. Testosterone plays important roles in normal growth and development, and its levels decline with age in both men and women. Here, we review emerging evidence that suggests testosterone influences myocardial function at the cellular level by modifying processes involved in intracellular Ca2+ homeostasis. Cardiovascular diseases are a leading cause of hospitalization and death for both men and women . Regression analysis has demonstrated that even when the effects of such comorbid conditions are controlled for the relationship between CAD and lower testosterone levels remains.2, 26 Furthermore, if hypogonadism was a consequence of CAD, it might be expected that patients with more severe CAD might have lower testosterone levels than those with milder disease. One study of over 900 men found that both total and bioavailable testosterone were significantly lower in men with coronary artery disease than in those without.42 The magnitude of the difference in testosterone levels between men with coronary artery disease and those without is clinically significant. Despite some heterogeneity, the majority of studies that investigated androgen levels in men with coronary disease, showed that testosterone levels were significantly lower in men with coronary disease than in matched controls. Contrary to the notion that higher testosterone levels account for the higher burden of coronary disease in men than women, there is an increasing body of literature indicating that men with coronary artery disease (CAD) have significantly lower testosterone levels than men without CAD. They further proposed that testosterone may compete with other vasodilatory compounds in a way that induces vasoconstriction.41 Ceballos et al did not investigate a mechanism in this study. These authors also acknowledged the previously described vasodilatory effects of testosterone. Male rabbits were given a weekly intramuscular injection of testosterone (25 mg/kg) or no treatment. Even though there is much evidence suggesting that testosterone may cause arterial vasodilation,17–22 some studies suggest that testosterone may constrict blood vessels under certain circumstances. Many studies suggest that testosterone inhibits atherosclerosis,31–37 whereas some studies suggest that testosterone may be detrimental.38–39 Because of this discrepancy, more research is necessary to completely understand the association between testosterone and atherosclerosis. The best way to find out if you have low testosterone is by doing a blood test.We additionally evaluated the effects of exercise on sex hormones by baseline age and baseline testosterone level.Thus, apparent prolongation of APD by testosterone may be due to estradiol produced by aromatization.Observational cohort studies, case-control studies, nested case-control studies, cross-sectional studies, case series, and case reports will also not be included.When cortisol stays high, testosterone production decreases.Similarly, AR knockout mice (ARKO) showed increased aortic atherosclerosis, and atherosclerotic lesion area that was reduced with T treatment (95). Four additional studies have confirmed these results, although it should be noted that none has accounted for both bioavailable testosterone and subclinical CAD simultaneously (Table 1).13,15–16,18 These results were confirmed by Rosano et al,17 who showed once again that patients with catheterization‐proven CAD had statistically significant lower levels of bioavailable testosterone. However, more research is required to definitively determine whether bioavailable testosterone is superior to free testosterone as a marker of hormone activity. Similar consideration should be given to the effects of obesity and insulin resistance on sex hormone–binding globulin (SHBG). For instance, obesity is an important factor that must be considered when analyzing testosterone studies. HIIT training gets your heart pumping and can be cardio or weight-based.The indication of an association between testosterone therapy and risk for adverse cardiovascular events prompted the US Food and Drug Administration (FDA) to issue a safety warning on testosterone therapy for older men, which was followed by a reduction in testosterone prescriptions.30 The safety warning cautioned against the use of testosterone therapy for aging-related decline and reinforced the current approval of testosterone products for hypogonadal men only.30 However, it is important to note that the methodology and reliability of the aforementioned studies have since been questioned.Studies show that strength training can actually induce the release of growth hormone and testosterone regardless of age.If you experience these side effects, immediately contact your doctor.However, short “bursts,” of exercise (i.e. quick cardio sessions), can stimulate a testosterone response that encourages higher ongoing levels.This is interesting because testosterone and cortisol levels naturally peak in the morning.Testosterone supplements can relieve symptoms in these men, such as erectile dysfunction, low energy levels, decreased muscle mass, and poor bone strength.Thankfully there are many ways to restore healthy testosterone levels, including exercise, dietary changes, and natural supplements. This can help ease the process of going to bed earlier and help you get the vital rest you need to combat low testosterone and other hormone imbalances. When your body gets plenty of sleep, it’s increasing testosterone naturally. The importance of sleep to a healthy body can’t be overstated, especially if you are working out a lot. Too much exercise can increase stress, which can, in turn, reduce the effectiveness of your exercise routine. We assessed the preceding 12-month physical activity at baseline, and preceding 3-month physical activity at 3, 6, 9, and 12 months, among exercisers and controls.Can low testosterone contribute to anxiety or depression?This training is an effective workout to boost testosterone in men and women while providing additional health benefits.By contrast, the density of 1,4-dihydropyridine (DHP) receptors (L-type Ca2+ channels) is markedly reduced by GDX in hearts from male rodents, and this effect is reversed by testosterone replacement 90,91.The results showed no post-training changes in aerobic capacity (VO2max), whereas significant improvements were observed in the muscle strength of the upper body, upper limbs, and lower limbs.The effects of testosterone replacement therapy on BMI were investigated by Kalinchenko et al in 113 men with metabolic syndrome, who received a total of 3 intramuscular injections of testosterone—at baseline and after 6 and 18 weeks.71 Patients receiving testosterone replacement therapy were shown to have statistically significant improvement in their BMI, which had decreased by 1.3 at 30 weeks.71 Testosterone replacement therapy has also been shown to decrease fat mass.Further work will undoubtedly expand our knowledge regarding the underlying mechanisms and relationships between low testosterone and coronary disease and this will be of great interest. How does body composition affect testosterone levels? However, the authors of that study noted that the available RCT data might have had inadequate power to detect an increased risk. Pending an adequately powered T RCT to clarify its effect on the risk of cardiovascular events, retrospective case-control studies have sought to fill this gap (Table 5). Clearly, the results of the TRAVERSE study, a testosterone cardiovascular safety trial, will be of considerable interest (195). There was no increase in risk of adverse events such as cardiovascular death, MI or stroke (191). Strength exercises include weightlifting. HIIT involves engaging in intense short bursts of exercises such as sprints, squats, burpees, and jumping jacks, with periods of rest in between. Rest and adequate sleep are also important components of an exercise program. The prognostic value of testosterone was demonstrated in 167 Chinese men with CHF who were followed up for at least 3 years.60 Compared with those with normal testosterone levels, patients with low testosterone levels had more severe cardiac dysfunction, a higher prevalence of ischemic etiology, and more comorbidities. Most studies addressing the issue of testosterone in heart failure have examined patients with systolic dysfunction (Table 1). Pro-inflammatory cytokines (tumor necrosis factor-α TNF-α and interleukin-1β IL-1β and IL-6) are known to regulate the hypothalamic–pituitary axis, resulting in reduced testicular production of testosterone.53 Another mechanism could be an increase in SHBG levels in the presence of inflammation. The testosterone concentration is lower in men with HF of any etiology than that in healthy men and is correlated with the severity of the disease. The heart demands a continuous supply of energy to maintain muscle excitation–contraction coupling, and in heart failure, energy is wasted at the cellular level.45 In a rat model of doxorubicin-induced cardiomyopathy, decreased effectiveness of all energy-producing systems is observed. Testosterone infusions, 5 minutes prior to myocardial ischemia, were given at a concentration of 10 ng/mL, approximately physiological levels. T lymphocytes, B lymphocytes, and macrophages can produce IL‐10; thus, more research was necessary to determine the source of the IL‐10 increase. The sham‐castration group had a higher rupture and death rate, which also suggests that testosterone exacerbates the inflammatory response and the potential for cardiac rupture after MI.43 In males, the only significant difference was between the sham‐castration plus placebo group and the castration plus placebo group. In males, the testes‐intact plus placebo group had a significantly higher neutrophil density than the testes‐intact male plus estrogen group for the first 2 days after MI, suggesting estrogen inhibited neutrophil infiltration. How Exercise Affects Testosterone EXERCISE DOES IMPACT testosterone levels, but research suggests that the actual effect depends on several factors. Testosterone, the main male sex hormone that’s produced by the testicles, is anabolic and does help you build muscle. Testosterone levels can also run low if you’re overtraining or have low energy availability (eating too little to support your training demands). It is often found that men (and women) suffering from low testosterone or other hormone imbalances simply don’t have the energy levels they used to. Let’s talk a little about the role testosterone performs in the body before we jump into the specifics of testosterone and exercise. The testosterone-exercise dynamic is a self-perpetuating cycle, and both high-intensity endurance training and resistance training (weightlifting) have immediate and significant impacts on your testosterone. You have probably already heard that testosterone, exercise (including weightlifting), and lean muscle production are inherently connected. There is a high rate of prescription of testosterone despite its unclear effect on cardiovascular events in men. The longitudinal Cardiovascular Health Study failed to find an association between total and free testosterone levels and either incident CVD or mortality in older men. Speculation on the hormone's effects has led to decades of observational studies and reviews. Alternatively, it may be metabolized to other steroid hormones, such as dihydrotestosterone (DHT) or 17β-estradiol (E2), or by 5α-reductase and aromatase, respectively.5 DHT amplifies the effects of testosterone, as it is a highly active metabolite with a greater binding capacity and signalling induction potency. Some large observational and randomized studies have supported this conclusion, whereas others have suggested a cardioprotective role for testosterone. Cardiovascular disease (CVD) is the leading cause of death globally.1 Various factors increase the risk of CVD, including diabetes, obesity, hypertension, dyslipidemia, and increasing age. There is a pathway by which T treatment is expected to improve endothelial function as in vitro studies demonstrate stimulation of nitric oxide synthesis in human aortic endothelial cells exposed to T (143). However, other studies in middle-aged and older men did not show any effect of transdermal T treatment on endothelial function (141,142). In a RCT of 55 obese men with type 2 diabetes, one year’s treatment with T undecanoate given as a depot intramuscular injection every 10 weeks improved endothelial function compared to placebo (140). A study in hypogonadal older men found an improvement in arterial stiffness with transdermal T therapy (139). These experimental rabbits were compared with control rabbits given a standard diet. Male rabbits with or without testosterone supplementation were fed a high‐fat diet. MetS encompasses hyperglycemia, hypertension, dyslipidemia, and central obesity.24 Filipi et al24 investigated the relationship between testosterone and MetS. The authors examined smooth muscle cells from rats using whole‐cell patch‐clamps to record electrical currents. Scragg et al23 examined the possibility that testosterone is an inhibitor of voltage‐gated calcium (Ca2+) channels. Gordon et al35 performed yet another study investigating atherosclerosis in rabbits fed a high‐cholesterol diet. However, DHEA‐treated rabbits had 40% less formation of fatty streaks, an early indicator of atherosclerosis, compared with control rabbits.34 Orchiectomized rabbits were given either oral dehydroepiandrosterone (DHEA), oral testosterone undecanoate (TU), intramuscular testosterone enanthate (TE), or placebo. Engaging in regular cardio workouts is an effective way to boost testosterone levels naturally. However, excess testosterone can lead to overproduction of blood cells, which may contribute to an increased risk of stroke. This balanced approach ensures that you maintain both optimal hormone levels and cardiovascular well-being. Estradiol treatment in the female rabbits and testosterone treatment in the male rabbits inhibited the buildup of atherosclerotic plaque compared with that in the control groups. This suggests that poorly controlled DM may decrease testosterone levels, which suggests that low testosterone levels do not lead to diabetes,28 confirming the previously described study. In a study by Jackson and Hutson, diabetes was chemically induced in rats of both sexes.27 Diabetic rats showed significantly higher blood glucose levels accompanied by statistically lower levels of luteinizing hormone (LH), follicle‐stimulating hormone (FSH), insulin, and testosterone than control rats. Deenadayalu et al18 performed a similar study using the left anterior descending (LAD) coronary arteries of swine hearts. Statistical significance was observed at both 1 and 10 μmol/L of testosterone, and there was no difference between the groups with and without endothelium.16 This suggests that testosterone has a direct smooth muscle–relaxing effect and does not require endothelium to induce vasodilation. The relaxation percentage, which is the amount of relaxation induced by testosterone compared with the contraction induced by prostaglandin, was determined. Effects of a therapy on blood vessels that have been subjected to endothelial denudation would suggest that the drug is working through an endothelium‐independent and NO‐mediated‐independent mechanism, such as directly on the tunica media (smooth muscle layer) of an artery. Surprisingly, until a recent study of HIIT in sedentary aging men (21), there were no data on the impact of HIIT exercise on muscle power in aging men. The relationship between testosterone and exercise in older males is a topic of ongoing debate and equivocal research findings (12, 13, 14). Alizade et al. suggested that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were increased in bodybuilders that used AS, and this may lead to ventricular arrhythmias . Baggish et al. also found that there was an increase in coronary artery plaque volume in AS users when compared to non-user, leading to rapidly progressive coronary artery disease . Alizade et al. found an increase in right ventricular heart strain with the use of a two‐dimensional speckle tracking echocardiography . Basaria et al evaluated the safety and efficacy of daily application of transdermal testosterone gel in 209 men.150 Given the increased rate of adverse cardiovascular events in the testosterone group, the study was stopped prematurely. Although the results of the 3 meta‐analyses seem to indicate that testosterone replacement therapy does not cause an increase in the rate of adverse cardiovascular events,31,146–147 a study published by Basaria et al in 2010 reported contradictory results. These authors demonstrated that the association between testosterone levels and IMT was independent of cardiovascular disease. BT indicates bioavailable testosterone; CAD, coronary artery disease; CCS, case–control study; CHD, coronary heart disease; CI, confidence interval; CS, cohort study; CV, cardiovascular; FAI, free androgen index; FT, free testosterone; FU, follow‐up study; HR, hazard ratio; OR, odds ratio; TT, total testosterone. A total of 7 population‐based studies analyzed the association between mortality secondary to cardiovascular disease and levels of total testosterone. In the present study, participants dramatically reduced their training volume from ~281 min/week to 4.5 min/week (excluding active recovery) or 27 min/week (including active recovery). To allow for comparison with existing literature, training intensities were compared with power achieved at VO2peak. Between assessment phases A and B, participants were instructed to maintain their habitual training practices, which were recorded by heart rate telemetry and training diaries.