Testosterone Therapy for Men: Is it safe? We know the effects of low testosterone on aging men; frailty, muscle loss, weight gain, impaired cognition, fatigue, loss of self-confidence, depression, declining bone health, increased risk of type 2 diabetes, stroke, and cardiovascular disease. But some headlines suggest it may increase cardiovascular disease. Heres Marvins take on the subject. ------------------------ BEWARE OF WHAT YOU READ Here we go again. The old adage that you can spin statistics to support whatever you want has reared its ugly head again. How often we are misled by a study based on the inference of the summary. So few of us are equipped to thoroughly critique a study; to evaluate the selection of candidates, or the chosen set of criteria or even the selection of studies on which a meta-analysis is based. How many times have we heard of the omissions from a study many years after the interpretation has been put into practice that if included would have led to a different conclusion. For the lay person it is extremely important to seek an unbiased critique of a particular study before subjecting themselves to a treatment based on that study. Recently on Medscape, I read an article linking testosterone supplementation in men to increased risk of cardiovascular disease. The fact that this study states that higher levels of testosterone in older men are unhealthy when similar levels in younger men are healthy should trigger a closer look at the details of the study carried out by a knowledgeable critic in order to illustrate the short- comings of the study. In this case the logic is based on the fact that younger men with higher levels of testosterone are healthier and at lower cardiovascular risk than older men with lower levels of testosterone. Although the risk of cardiovascular disease involves numerous factors as well as testosterone levels, everything else being equal, the conclusion of this study flies in the face of logic. This conflict is discussed in Medscape Medical News 2013 WebMD, LLC. In another article on Medscape citing a 5 year observational study following men with hypogonadism supplementing with testosterone indicated many advantages to increased testosterone levels relevant to CVD risk factors. These included decreased LDL-cholesterol levels, increased HDL-cholesterol levels, reduction in weight and waist circumference, decrease in BP, fasting blood glucose levels, and C-reactive protein. I recently read an informed in-depth analysis of the study on the Life Extension website. In this article the writers point to the well referenced literature of the effects of low testosterone on aging men such as frailty, muscle loss, weight gain, impaired cognition, fatigue, loss of self-confidence, depression, declining bone health, increased risk of type 2 diabetes, stroke, and cardiovascular disease. They clearly underlined the shortcomings in the study’s design and methodology. They explain that the testosterone level of the subjects in the study done by Vigen was increased but only to a higher level of low and that the level of testosterone shown to be of benefit was at a higher level more in line with men of a younger age. These levels of 550ng/dl or higher were never reached or strived for in the Vigen retrospective and observational study. They also stated that the aromatase enzyme which increases with age was not considered. This enzyme converts testosterone to estrogen and is detrimental to men’s health when the levels climb too high. They stressed the importance of the type and form of the testosterone used. Synthetic testosterone in the form of injection or patch was used instead of bio-identical testosterone gel which produces a more natural physiologic response. Unfortunately, basing the story only on the study’s summary, the news headlines spoke of the supposed negative impact of testosterone replacement in older males. In so doing the media has featured the conclusions of the Vigen study as if it were the definitive truth not giving any credence whatsoever to previous research and conclusions that are quite to the contrary. How many lay people and professionals will base their treatment decisions on a flawed study claiming supposed negative effects of higher testosterone levels in older men? Seeking the higher youthful levels as indicated by more reliable sources of information will undoubtedly lead to better outcomes. I reiterate how important it is to not accept the conclusion of health studies at face value but to look into the informed critiques of these studies. You and your health care practitioner will then be able to make a more informed decision on optimizing your health. 1) Testosterone Therapy Linked With Adverse CVD Events. Medscape. Nov 05, 2013. 2) Vegen R, O’donnell, Baron AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. Jama 2013; 310:1829-1835 3) Cappola AR. Testosterone therapy and risk of cardiovascular disease in men. Jama 2013; 310:1805-1806 4) Lisa Nainggolan- Testosterone Conundrum: New Study Yields Clues Nov. 22, 2013 5) Five Years of Testosterone Ameliorates Metabolic Syndrome in Hypogonadal Men. Medscape. Oct 28, 2013 6) Blake Gossard, Kira Schmidt,ND, Luke Huber, ND, Steven V. Joyal, MD – Flawed Testosterone Analysis Spurs Misleading Media Headlines.
Posted on: Sat, 24 May 2014 12:18:05 +0000
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