Men and Testosterone.

 

Yes Testosterone is safe and beneficial.

The controversy and concern of men taking Testosterone 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 Testosterone (T) therapy. All 9 resolutions received unanimous approval indicating that the science and clinical evidence behind these resolutions is strong and well established.

 

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 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

 

RESOLUTON 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.

 

I prescribe bio-identical Testosterone for those who have symptoms and/or are less that 50% of the lab range for testosterone. But I also believe that replacing Testosterone with bioidentical T must be combined with lifestyle modifications, changes in diet and increased levels of exercise which will have a positive impact on health, quality of life and to look and feel younger and better.

Bio-identical hormone replacement therapy requires a holistic approach to optimize your health.

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