Harvard Heart Letter

Special section: Cardiovascular connections: Testosterone, sex, and the heart

Special section: Cardiovascular connections

Testosterone, sex, and the heart

Testosterone was once thought to be bad for the heart, a key driver behind the earlier appearance of heart disease in men than in women. But a growing body of research indicates that for older men, it's too little testosterone that poses problems. In men, testosterone helps blood vessels relax, widen, and carry more blood when needed. It improves blood pressure and cholesterol levels and may positively influence electrical conduction in the heart. Low testosterone has been linked to a host of health problems in men, ranging from the development of type 2 diabetes to bone loss, depression, and loss of interest in sex.

Cholesterol-clogged arteries can also derail sexual activity. When a touch, a look, even a thought nudges the brain to send signals of arousal, arteries in the penis relax and widen. Extra blood flows into the penis, making the tissue more rigid and compressing small veins that drain blood away from the penis. The accumulation of fatty plaque inside blood vessels throughout the body can interfere with this process, weakening or preventing an erection.

Erection problems warrant a thorough check-up for signs of heart disease. This includes testing for high cholesterol, high blood pressure, and diabetes, along with a conversation about symptoms that might suggest atherosclerosis elsewhere in the body, such as chest pressure, episodes of breathlessness, or pain in the calf muscles while walking. A sustained focus on exercise, healthy eating, and not smoking could improve heart health and sexual function.

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