In April 2013, researchers writing in BMC Medicine had sorted through thousands of results in 27 clinical trials and also determined that the risk of cardiovascular events went up for men on testosterone. (Curiously, this risk became apparent only in trials that were not paid for by the makers of the drugs.) Then in November 2013, researchers for Colorado’s Veteran’s Affairs system wrote in the Journal of the American Medical Association that they’d analysed the data from 8,000 men with low T who had gotten an angiogram before going on the hormone. Three years after starting, 26 percent of the men on testosterone had either experienced a new cardiovascular event or died, versus only 20 per cent of the men who didn’t take testosterone.
Another alarm sounded in 2014, when a study in the journal PLOS One, looked at the health records of 55,000 men and found that testosterone use had doubled the risk of non-fatal heart attack in men over 65 and tripled the risk in younger men with a history of heart disease (younger men with no heart disease fared well on the drug).
“The PLOS One paper excluded anybody who died of a heart attack,” says John Morley, MD, a low-testosterone expert at Saint Louis University School of Medicine. “It may well be they found a higher level of heart attacks in men on testosterone because those men lived while the others (who didn’t take it) died.”
As for the NEJM study of older men and mobility, “It is good that it was a random controlled trial,” says Martin Miner, MD, co-director of the Men’s Health Centre at Miriam Hospital in Providence, Rhode Island. “But what was poor was that it really wasn’t a safety study. We don’t normally start elderly men with a history of heart failure on such large doses of testosterone.” In other words, the research wasn’t the best way to find out if testosterone is dangerous.
Blame the fog of T research. “I’m not saying testosterone is safe or unsafe,” says Dr. Miner. “I’m just saying those studies are so complicated, that for the lay public to interpret from them that a product causes significant risk is inappropriate. And just because heart disease is associated with low testosterone doesn’t mean it was caused by it,” he adds.
This confusion is why many of the nation’s hormone experts specifically recommend against screening for low T; they just can’t say whether low T is an important health problem or not.
“We don’t know that low testosterone is the primary reason people feel rotten or without much drive,” says Victor Montori, MD, an endocrinologist at the Mayo Clinic. “After age 45, men lose a small amount of testosterone each year. If losing testosterone made you feel bad, then there should be more 70-year-olds feeling robbed of life than 60-year-olds, and so on. I haven’t seen that data.” Moreover, doctors can’t even agree on what a healthy level of testosterone is. “This is why no one should ever make the diagnosis of low testosterone without seeing some sort of symptoms,” he says.
The inflated promises of TRT start with the idea that it can inflate your dick, not to mention the suggestion that erectile problems are even reliably related to testosterone deficiency. A 2011 review from Imperial College London, for instance, found “no relationship between testosterone level and the severity of erectile dysfunction.” (While impaired sexual function is required for the diagnosis of late-onset hypogonadism, most men with erectile dysfunction have normal T levels.)
What can testosterone do? “When you look at clinical trials of people with moderate or mild low testosterone receiving physiologic testosterone replacement,” says Dr. Montori, “the impact on quality of life and sexual function is either minimal or nonexistent.”
Dr. Morley disagrees: “Poor libido and a poor quality of erection are the symptoms most related to poor testosterone,” he says. “There is also a subset of people with low testosterone who have fatigue, who are unhappy, and who don’t have strength. They look like they’re depressed, but they actually have low testosterone.” Except here, too, the science isn’t on his side: The European Male Ageing Study results also show that psychological symptoms had little or no association with testosterone levels.
Source: Men’s Health India magazine