A new study from the American Heart Association has quite decisively concluded that the answer to that question is, in fact, exercise. The study was led by researchers at the University of Western Australia (source).

We know that as men get older, both their testosterone levels and (quite often as a result) physical activity tend to decrease. This then coincides with a heightened risk of developing cardiovascular disease.

Researchers set out to examine both the effects of a 12-week exercise program, using stationary bikes and resistance training machines, and testosterone treatment on artery function. Both are a determinant of future cardiovascular risk and health.

The study included seventy-eight men aged between 50 to 70 with low-to-medium testosterone levels and no history of cardiovascular disease. None had a waist measurement of 95 centimetres (37.5 inches) or more, and they were randomly assigned to four groups:

> 21 who received a testosterone cream that was applied to the skin daily, along with aerobic and strength training two to three times a week

> 18 who received testosterone cream with no exercise training

> 19 who received a placebo with exercise training

> 20 who received a placebo and no exercise training.

Participants in the study had ultrasound scans at the beginning and end of the trial. They also had a series of other tests to monitor their artery diameter responses to changes in blood flow.

The findings showed artery function improved most – by 28% – for the cohort that undertook exercise training alone. This was followed by the group that followed a combined protocol of exercise and testosterone (19%).

However, one important finding was that no improvement in artery function was observed in the group that received testosterone therapy alone.

While there has been evidence before – that testosterone therapy can help men build muscle mass and strength, this particular study found exercise was more effective at reducing body fat and developing lean body mass than the hormone treatment.

GP Dr Jennifer Graham-Taylor, Chair of the RACGP Specific Interests Sport and Exercise network, told newsGP the findings are ‘important’ and provide further support for current practice.

“In older patients with low normal testosterone levels the risk of hormone replacement may outweigh potential benefits. However, the multiple benefits of exercise in all aspects of health, including vascular health, are well established.”

Despite the controversy over testosterone supplementation and cardiovascular risk, globally sales increased 12-fold from 2000–2011.

In the UK, you can only get testosterone supplementation legally via your GP. Most men who are considering acquiring from a ‘black market’ source need to be careful for all sorts of reasons. Not least, they can increase the thickness of blood and cause blood clots along with increasing their risk of pancreatic cancer and heart disease.

What this small study shows is that there is an unproven belief that testosterone therapy is somehow rejuvenating and might have anti-ageing effects.

Despite the study using a relatively small sample, Adjunct Professor Trevor Shilton, Director of the Heart Foundation, says the findings are “very promising”.

“Physical activity is such a powerful tonic, if you like, for preventing and managing chronic conditions, including heart disease, but also diabetes and cancers. There’s also evidence on arterial health combined with what we know about weight gain, blood pressure and cholesterol.”

It is recommended in the UK that adults be active most days, with at least 150 minutes of moderate physical activity or 75 minutes of vigorous activity per week, coupled with strength training at least twice a week.

According to figures published by the UK government in October 2020 – 63.3 per cent of people in England aged 16 and over were ‘physically active’ – doing the recommended 150 minutes or more of moderate-intensity physical activity a week (source).

However, NHS data on physical activity for the over 65s is not so encouraging though. Many over 65s spend, on average, 10 hours or more each day sitting or lying down, making them the most sedentary age group (source). Worse still, this figure falls with age reaching as low as 30 per cent for the over 75s (source – pdf doc).

Adjunct Professor Shilton says the study’s findings of exercise versus testosterone are particularly important for GPs, who regularly manage chronic disease and undertake health checks and risk assessments.

‘It’s very important to understand that in terms of your cardiovascular risk, it’s never too late to start being fit.”