Testosterone therapy has risks

images-1From the Boston Globe comes this story; Testosterone commercials promise renewed energy and libido but whether men should get tested and treated for “low-T” – as drug company ads call it — remains controversial because of unknown risks of long-term testosterone therapy and hints that it could cause life-threatening health problems in older men who tend to have the lowest levels.

Researchers at the New England Research Institutes are conducting an observational study involving nearly 1,000 men over age 18 who are being treated with long-term testosterone therapy to boost low hormone levels in order to determine whether it raises their risk of prostate cancer.

A 2010 study published in the New England Journal of Medicine found that men over 65 years of age with low testosterone levels who were treated with a daily testosterone gel for six months gained muscle strength and endurance compared with those who used a placebo gel but also had more heart attacks. Out of 209 study participants, 23 in the testosterone group had a heart attack, a blocked artery that required treatment, or died of heart problems during the study, compared with 5 in the placebo group.


About 2 to 5 percent of men under age 40 have low testosterone, according to Dr. Brad Anawalt, chief of medicine at the University of Washington Medical Center and chair of the Endocrine Society’s Hormone Health Network. The percentage gradually rises to the point that one in four men over age 70 have low levels. But just as most women don’t need hormone replacement therapy after menopause, men usually don’t need testosterone replacement in their senior years. “It all depends on how much they’re bothered by symptoms,” said Anawalt.

Getting a proper reading on a test can be tricky, however, because blood tests can be notoriously unreliable. Because testosterone levels tend to decline throughout the day, getting tested between 7 and 10 a.m. is ideal. “About 15 percent of men with normal testosterone levels in the morning will have a reading that comes back low later in the day,” Anawalt said. “I get a lot of referrals from doctors who took the test at the wrong time of day or who used a type of free testosterone test that often comes back with a false low reading.”

A 2012 study involving 1,031 male veterans with a testosterone deficiency who were followed for up to five years found that those who were given testosterone gels or creams had a 10 percent risk of dying during the course of the study compared with a 20 percent risk in those with low levels who weren’t treated. The researchers from Veterans Affairs Puget Sound Health Care System acknowledged, however, that certain confounding factors, such as better quality health care, might have accounted for the testosterone takers’ decreased mortality.

Testosterone treatment also has side effects including shrunken testicles, hair loss, acne, breast enlargement, and sterility.

While the T commercials on TV do contain fair balance one has to wonder if men are really evaluating the real risks of T therapy or see it as a ticket to turn back their biological clocks ?  The reason that energy drinks and supplements are flying off the shelves is that we all want more energy after working more hours but I wonder how many physicians are writing an Rx for low T rather than telling men that one sure way to get back energy is to lose weight and exercise.


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