by Stephen Roberts
According to the Massachusetts Male Aging Study approximately 2.4 million men aged 40 – 69 have low testosterone (hypogonadism).
Hypogonadism has far reaching effects. Testosterone has been positively related to energy and stamina, erections, sexual desire, lean muscle mass and strength, percent of body fat, bone strength and mood.
Dr. Daniel Moskovic from the Baylor College of Medicine, and his colleagues, carried out a statistical analysis to determine the impact of testosterone deficiency. The study estimates that, over a 20 year span, low testosterone will result in 1.3 million cases of cardiovascular disease, 1.1 million cases of diabetes and 600,000 cases of bone fractures in the United States with and estimated cost of as much as 525 billion dollars in health care expenditures.
A 2014 study, that investigated the effects of long term testosterone treatment (T therapy) of 261 elderly men with hypogonadism and erectile dysfunction, found that the testosterone treatment resulted in decreased body weight and waist circumference, and lower cholesterol, triglycerides, fasting blood glucose and blood pressure. Erectile function was improved and HDL (good) cholesterol was increased with a lessening of muscle and joint pain.
Not everyone feels that prescribing testosterone for aging males is appropriate however. Concerns are expressed about testosterone treatment include: stimulation of the growth of prostate cancer (PCa), increased risk of heart attack, benign prostatic growth, sleep apnea and an upturn in hematocrit levels and the risk of blood clots.
To address the concern about testosterone therapy worsening the risk of prostate cancer, an investigation reported in the January 2015 issue of The Journal of Urology by Ahmad Haider and associates, showed the effects of over a thousand men with low testosterone who were given T therapy for an average of 5 years. This study showed that the level of PCa found in the study patients was no greater than in the general population. T therapy, in that study, did not increase PCa. In another review, an analysis of 19 studies compared men who received T therapy with men who received a placebo. There was not a statistically significant difference in the number of prostate cancers found in the two groups.
In a comprehensive 2015 review article of the journal of the American Heart Association the issue of T treatment increasing the risk of cardiovascular disease was addressed. The authors conclude that men with low testosterone are more likely to die from cardiovascular causes. The study also found that the severity of coronary artery disease and congestive heart failure is in fact related to the degree of testosterone deficiency. No recommendation has been made at this point to treat men with existing heart disease with testosterone.
As the benefits of testosterone become more known and the fears of possible negative outcomes decrease, it is understandable that more men are being prescribed testosterone. It appears however that many healthcare professionals are deviating from prescribing practices recommended by the Endocrine Society. T therapy is often prescribed without first determining if the patient actually has low testosterone. Many are also being prescribed testosterone without first determining their risk for prostate cancer or heart disease. Also of concern to some researchers is the impact of testosterone treatment on estrogen levels, which has been implicated in sudden cardiac arrest.
If testosterone is to be prescribed, more thorough monitoring by healthcare professionals is warranted. Many feel that further research about the safety and effectiveness of T therapy is also needed, since not all research supports the positive findings of the studies mentioned in this article.
After graduating from the University of Illinois with his PhD in Health Education, Stephen Roberts has served as a faculty member at Kent State University
and the University of Toledo School Of Health Science and Human Service for 35 years as a teacher, researcher and advocate in the areas of health promotion and public health.