The Experts Agree: Testosterone is Safe and Effective for Men's Health
Updated: Sep 26, 2020
The controversy and concern of men taking Testosterone (T) was finally laid out and published in the Mayo Clinic Proceedings 2016. Participants of the conference were invited based on their clinical and/or research expertise with Testosterone deficiency (TD) and represented a broad range of specialties from 11 countries on 4 continents.
The expert panel vigorously debated 9 resolutions regarding TD and T therapy. All 9 resolutions received unanimous approval indicating that the science and clinical evidence behind these resolutions is strong and well established.
Listed below are the 9 resolutions that were discussed and agreed upon..
Resolution 1
TD is a well-established, significant medical condition that negatively affects male sexuality, reproduction, general health and quality of life
Testosterone affects multiple organ systems including the brain, peripheral nerves, muscle, fat, bone, CV system and reproductive system
T regulates the metabolism of carbohydrates, lipids and proteins and influences muscle growth and adipogenesis.
Low T = increased risk of developing diabetes, metabolic syndrome, decreased bone density and contributes to increased all-cause and cardiovascular mortality
Resolution 2
The symptoms and signs of TD occur as a result of low levels of T and may benefit from treatment regardless of an identified underlying etiology
Historically recognized causes of TD are rare and only account for a small fraction of men with TD
No evidence exists to support restriction of T therapy only to men with known underlying etiology
Resolution 3
TD is a global public health concern
Prevalence rates in men range from 2 to 38% in world-wide studies
A US study estimates an additional $190-$525 billion in health care expenditures over 20 years due to TD
Resolution 4
T therapy for men with TD is effective, rational and evidence based.
High-level evidence shows T therapy effectively increases libido, increases lean body mass, decrease fat mass, improves bone mineral density.
Strongly suggestive evidence for improvement in mood energy
Resolution 5
There is no T concentration threshold that reliably distinguishes those who will respond to treatment and those who will not.
Interpretation of total T concentrations vary between who will experience signs and symptoms of TD due to individual variation and the amount of T bound to SHBG and thus not bioavailable to be active
Resolution 6
There is no scientific bases for any age-specific recommendations against the use of T therapy in men
The term age-related hypogonadism is of questionable validity since the decline in mean serum T level with age is minor and primarily attributed to comorbidities especially diabetes
It is illogical to single out TD as the one medical condition among many (eg diabetes, hypertension, heart disease, cancer, arthritis) that does not merit treatment because it becomes more prevalent with age
Resolution 7
The evidence does not support increased risks of CV events with T therapy
Two observational studies received intense media attention after reporting increases in CV risks. Both had major flaws/limitations. One misreported results, the other had no control group.
Low serum T is associated with increased atherosclerosis, CAD, obesity, diabetes and mortality
Several RCT’s in men with known heart disease showed greater benefits with T vs placebo.
Resolution 8
The evidence does not support increased risk of prostate cancer with T therapy
T therapy has no greater risk of Pca than placebo
Aggressive/high-grade Pca is associated with low T levels
Early data suggests no increased risk of recurrence/progression of Pca with T therapy in men previously treated for Pca
Resolution 9
The evidence supports a major research initiative to explore possible benefit of T therapy for cardiometabolic disease, including diabetes
A large body of evidence suggests lower serum T concentrations are associated with increased CV risks
T therapy reliably increases lean mass, decreases fat mass, and may improve glycemic control
Mortality rates are reduced by half in men with TD who received T therapy compared with untreated men in observational studies
Among men who receive T therapy, those with normalized T levels had a reduced rate of CV events/mortality vs those with low T.
My Take?
I prescribe bio-identical testosterone (T) for those who have symptoms and/or are less that 50% of the lab range for T. But I also believe that replacing T with bio-identical T must be combined with lifestyle modifications, changes in diet and increased levels of exercise which will have a positive impact on health, and quality of life
Bio-identical hormone replacement therapy requires a holistic approach to optimize your health and longevity.
Morgentaler MD, Zitzmann MD et al: Fundamental Concepts Regarding Testosterone Deficiency and Treatment: International Expert Consensus Resolutions Diagnosis and Treatment Guidelines. Mayo Clinical Procedings. May 2016: 1-16
