Growing Concerns Reported Over the Safety of Testosterone Replacement Therapy
By now, I'm sure many of you have been subjected to the ongoing marketing blitz about testosterone therapy for treating "low T". Touted as a way to make men feel more alert, energetic, mentally sharp, and sexually functional, millions of American men are using a prescription testosterone gel, patch, or injection to boost testosterone levels. Although testosterone therapy isn't approved for age-related conditions and the natural, age-related decline in testosterone levels, a FDA loophole permits aggressive direct-to-consumer marketing urging men to talk to their doctors if they have certain "possible signs" of testosterone deficiency, including common things like feeling tired. As a result, testosterone replacement has exploded into a multi-billion dollar industry over the course of the last two decades. In fact, according to researchers at UCLA, testosterone replacement has been marketed so successfully in recent years that sales of Androgel, a testosterone therapy, eclipsed sales of Viagra in 2013. However, a growing body of evidence has raised alarming concerns that testosterone treatment could be deadly.
A number of recent studies have found that men taking testosterone have more cardiovascular problems, including heart attacks, strokes, and deaths from heart disease. Testosterone therapy is also suspected to stimulate the growth of prostate cancer cells. Concerns first arose in 2010, when the National Institute on Aging (NIA) halted a testosterone trial after cardiovascular-related problems were reported in the testosterone group. Another study from the Veteran Affairs system soon followed linking testosterone therapy to an increased risk of heart attack, stroke and death. But the largest study to date, a PLOS ONE study of 55,000 men, suggests a doubling of heart attack risk within 90 days after beginning testosterone therapy. This study found an increased risk in men younger than 65 with a history of heart disease, and in older men even if they didn't have a history of the disease.
The theory underpinning these alarming cardiovascular findings involves the effect of testosterone in blood. According to the PLOS ONE researchers that conducted the study, testosterone is believed to promote clotting, which can be particularly problematic for older men, who tend to have thinner blood vessels, but is of concern for all men taking testosterone replacements. According to Dr. Carl Pallais, an endocrinologist and assistant professor of medicine at Harvard Medical School, "[t]here is a bit of a testosterone trap[.] Men get started on testosterone replacement and they feel better, but then it's hard to come off of it. On treatment, the body stops making testosterone. Men can often feel a big difference when they stop therapy because their body's testosterone production has not yet recovered." This effect tends to promote long-term, indefinite testosterone supplementation and concomitant exposure to its side effects.
For now, doctors are urging caution in decision-making when it comes to "off-label" testosterone therapy and men are being urged to:
- consider other reasons why they may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone (i.e. not eating a balanced, nutritious diet, exercising regularly or sleeping well)
- ruling out relationship or psychological issues that could be contributing to a change in sex drive or investigating underlying cardiovascular issues as a source of erectile dysfunction
- get an accurate assessment of their testosterone levels - testosterone level should be measured at peak time between 7 am and 10 am and any low levels should be confirmed with a second test on a different day
- follow-up with your physician periodically if you are on testosterone replacement for lab tests to check for any prostate or blood chemistry problems
Keep in mind that, despite the marketing hype, testosterone therapy is not a fountain of youth. There is no proof that testosterone replacement restores youthful levels of physical fitness or sexual function, promotes longevity, prevents heart disease or prostate cancer, or improves memory or mental sharpness. If you are considering testosterone therapy, it is best to temper your expectations and approach this therapy with diligence and caution. If you are looking to boost testosterone levels naturally, consider mastering weightlifting movements, like squats, dead lifts, power cleans and other compound movements that promote a natural increase in the body's production of testosterone.
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