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Anyone who’s watched television these days has seen the ads touting testosterone as the cure for a man’s midlife blues, and as a way to enhance his romantic life. But here’s what they don’t tell you.

The vast majority of midlife men in America have too much fat on their midsection. Male abdominal fat contains an enzyme called aromatase that converts testosterone into estrogen. Failing to compensate for the increased estrogen production may result in that already-suffering midlife man suddenly discovering that he is in need of a bra. Filling a C-cup is not the goal of the typical low-testosterone man.

So before your doctor puts you on testosterone, make sure he carefully follows your estrogen level. If your ratio of free testosterone to estrogen is not at least 7 to 1 in favor of testosterone, you need to be taking an estrogen blocker.

A low normal testosterone level may increase your risk of dying from a heart attack.

126 men who were admitted to the intensive care unit for fresh heart attacks had their testosterone levels evaluated. These men were then followed for the next 30 days to see how they did. 16 men died, and 110 men survived. However, 100% of the men who died had testosterone levels in the bottom 25 percentile of the normal range. Their testosterone was not low. In fact, it was within a range in which there are a few American doctors who would recommend testosterone supplementation, but everyone who died was within that low normal range.

Once more, we have good evidence that being normal is not enough. Where you are within the normal range can make the difference in living and dying. As I keep saying, normal is not acceptable. Shoot for optimal.

One of the common therapies used in prostate cancer are drugs that interfere with a man’s production of testosterone. While this does slow tumor growth, there is a downside.

With low testosterone men are at higher risk of forming blood clots in their legs, lungs and brain, not to mention sexual dysfunction, depression and chronic fatigue. As a consequence, many men end up taking anticoagulants to prevent those blood clots.

An interesting paper just published shows that men who use anticoagulants have significantly better survival from their cancers than men who do not need these drugs. This intriguing bit of data is causing researchers to take a look at the anticoagulants, such as warfarin and heparin, to see if they might have anti-cancer properties that have not previously been recognized.

Once more, studies designed to look at one thing, raise more intriguing new questions than they answer.

I’ve written about this before, but it bears repeating. In spite of what people often say, estrogen is not a hormone – estrogen is a class of hormones. When a female patient comes to Longevity Medical Clinic and we start discussing Hormone Replacement Therapy, it’s critically important that we use the right type of hormones to accomplish our goal. Women can benefit dramatically from Hormone Replacement Therapy. But they need to receive human type hormone, in doses that maximize benefits while minimizing risks, and the hormones should never be given by mouth.

Is their higher level of testosterone the reason men have an increased risk of heart disease compared to women? For many years doctors have thought so. This belief seems to have grown largely out of the fact that women generally tend to have lower risk of cardiovascular disease than men (at least until after menopause). Because estrogen has a significant anti-inflammatory effect in the blood vessels, and because we think of testosterone as the opposite of estrogen, for a long time the medical community presumed that testosterone must increase the inflammation that can lead to heart disease.

We now know that, like estrogen, testosterone also has a potent anti-inflammatory effect in the arteries. Testosterone isn’t part of the problem – but it can be part of the solution.