Surely, no medical saying is better known than “First, do no harm” and most of us in the medical profession live by that mantra. That’s why some doctors have been reluctant to prescribe testosterone replacement therapy (TRT) for patients suffering from low levels of the hormone in their bodies (low-T).
But a new review of low-T studies published in this month’s Mayo Clinic Proceedings found claims that TRT may increase cardiovascular risks to be exaggerated at best. In fact, not only did the review fail to turn up any evidence of risk of cardiovascular disease with TRT, it actually found some evidence that showed higher testosterone levels could be beneficial, reducing risk factors for these conditions.
So what’s going on here? Why the controversy? And what should you do about it?
Let’s start at the beginning. Testosterone is the male hormone responsible for the development of sexual characteristics, muscle mass, sense of wellbeing, and sexual function.
Around the age of 30, a man’s testosterone levels begin to drop by about 1 percent per year. Stress, alcoholism, obesity, certain medications, and chronic illnesses can speed up this drop. Many men find themselves overweight, disinterested, unable to perform in the bedroom, fatigued, depressed, or irritable, as their natural testosterone levels fall.
Doctors have known about testosterone and its effects on the body since at least the 1940s. What has changed is that, in recent years, many more men have been put on TRT, as drug companies have aggressively marketed gels and creams that make it easy to introduce the hormone into the body. Combine these pervasive advertisements with doctors who aren’t experienced prescribing testosterone, two studies that asked questions (but provided no answers) about the safety of this therapy, and a host of lawyers ready to pounce on any opportunity to file a malpractice lawsuit, and it’s clear why the FDA convened an advisory panel on the safety of TRT late last year.
The review, headed by Harvard Medical School Professor Dr. Abraham Morgentaler, looked at all of the studies published since 1940 and found that only four published scientific journal articles suggested increased cardiovascular risk with testosterone prescriptions, and found serious problems in the methodology of two of them. In contrast, the review found dozens of studies highlighting the cardiovascular and mortality risks associated with low-T.
Here’s the bottom line: Despite claims to the contrary, there is no evidence to support the idea that TRT may increase a man’s risk of developing or dying from cardiovascular disease.
That said, it is still a medical treatment, so men who experience symptoms related to low-T should find a doctor who specializes in dealing with this condition. They should demand a comprehensive evaluation and an individually tailored treatment plan, preferably using hormone replacement therapy (we’ll cover that another time). And they should expect close monitoring and substantive follow-up from their doctor.
For doctors, all of this is a lot of work; It takes more time and costs more money than simply prescribing the gel patients saw advertised. However, if we really believe our most famous mantra – “First, do no harm” – then we have to treat low-T like the medical condition that it truly is.
Dr. Christopher Asandra, M.D., is an experienced physician, innovative entrepreneur and passionate caregiver who has dedicated his medical practice to improving the lives of men across the country. As the Founder and Chief Medical Officer of NuMale Medical Centers, Dr. Asandra has helped thousands of men suffering from E.D., low testosterone and other sexual dysfunctions rediscover and revive their confidence, energy and relationships.