Testosterone therapy: ‘Cure’ looking for problem?

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Low T? OMG!

The pharmaceutical industry wants men to think their sex lives, muscle mass and energy levels are in trouble because of — oh my goodness — low testosterone

The promoters offer you a self-test, and guess what? About 49 percent of men who take the test are candidates for replacement.

Let me suggest six things that might be wrong with that picture.

  1. The manufacturer of AndroGel spent $80 million of the $3.47 billion the industry spent in 2012, according to The New York Times in an Oct. 15, 2013, article. Direct-to-consumer advertising is a strong driver of medical costs and it often promotes ineffective or dangerous products. It’s hard to convince patients that they were suckers of a sales pitch.

  2. The cost of one bottle, about one month’s supply, is quoted at more than $400.

  3. The risks from treatments are uncertain, but the list extends from prostate cancer to shortened life expectancy. Other concerns have included liver damage, overproduction of red cells, prostate enlargement, sleep apnea and worsening heart failure.

A study of 8,709 men was published Nov. 6, 2013 in the Journal of the American Medical Association. The men in that study all had risks for vascular disease and testosterone levels below 300 nanograms per milliliter.

The study was stopped because the testosterone-treated group had more heart attacks and strokes, and they also had a higher death rate — 27.7 percent compared to 19.9 percent in the untreated group.

  1. Doctors use average testosterone levels in young men as the standard for determining what is normal and what is not. It’s not reliable.

Individuals vary and the response to treatment is different depending on what you measure: muscle mass, strength, sexual function and so on.

  1. There’s a lot we don’t understand about possible benefits and risks. The chemistry is complicated.

For example, 80 percent of the female hormones in men arise from a chemical reaction with testosterone. More testosterone means more female hormones.

  1. I suspect the most important thing we have to learn is that the basic concept was a mistake, one we’ve made before. We haven’t seemed to benefit from history. What warnings did we have?

In the 1960s, I was fresh out of medical school and still doing some general practice with U.S. Army Special Forces and in my training programs. I joined the enthusiastic promoters of hormone therapy for women.

A famous author wrote that menopause was preventable and he toured, with industry support. It sounded good, at first.

In the next decade we realized there was an increased risk of uterine cancer.

The hope of reducing heart disease didn’t work out and there was an increase in the incidence of strokes.

By 2002, the increase in breast cancer caused us to back away from decades of belief in hormone replacement therapy — for women at least.

It hasn’t slowed the way we embraced the same idea for men.

Decreased thyroid function is also seen as people age. It may be related to an autoimmune process. Whatever the reason, old patients are often treated with thyroid supplements.

Older patients may require less thyroid hormone than younger ones because of metabolic changes, and they are more susceptible to complications, such as cardiac irregularities.

Thyroid therapy may be important, even life saving, but it’s not a good idea to give it to someone who is tired or wants to lose weight.

One more hormone that decreases with age is growth hormone. It has been promoted as the anti-aging factor.

Given by injections, it may cost $15,000 a year or more.

An early report showed improvement in muscle tone. Side effects can include diabetes, hypertension, joint pain and heart failure.

One theory links the process of aging to hormone failure. It is pointed out that the pituitary shrinks as we get older, and the pituitary is regarded as the master gland that controls the others.

There are a lot of reasons to argue that we should try to pump hormones back to youthful levels.

There are also compelling reasons to believe some of the decreases are adjustments that help us adapt to getting old.

It is absolutely clear that we can’t add one supplement and expect to have a single, uncomplicated result. Uncertainty isn’t likely to silence the quacks.

I define quackery as making claims that can’t be supported by evidence. Some quacks believe the noises they make.

Be careful.

Dr. Larry Mulkerin is a retired clinical professor and oncologist who lives in Walla Walla. A former U.S. Army Green Berets medical officer with experience in the Middle East, he also is the author of “The Ayatollah’s Suitcase,” a novel available at amazon.com and other online book retailers. He can be reached at mulkerin@charter.net.

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