This post is a follow-up to a previous post–Blinded with Science. I am reloading with more evidence on Testosterone therapy in men.
In this previous post, I documented the flaws of the 3 most recently publicized studies. A quick review is in order. One of the studies should be redacted due to numerous study design flaws and conclusions. Another study merely reflected the negative effects of massive Testosterone doping that is, unfortunately, far to common place under the guidance of physicians in aging men. The third study revealed an increase risk of non-fatal heart attacks in men older than 65 irrespective of whether cardiovascular disease existed and in those < 65 with pre-existing cardiovascular disease. I contrasted the numerous studies that showed the associations with low Testosterone and cardiovascular disease in men and documented the safety of Testosterone therapy in men with prior cardiovascular disease in those properly evaluated and properly followed. That though is the key to effective, safe Testosterone therapy–a physician or medical provider that has a strong working knowledge of Hormones. As simple as it would be to make men all about Testosterone, the history of Estrogen therapy in women makes clear the folly of this path.
What I did not document was whether Testosterone therapy actually improved metabolic function. Even better, can Testosterone reduce mortality?
In this addendum, I want to highlight recent findings that Testosterone is not just a biomarker of poor health in men, but in fact, Testosterone can be used to specifically improve metabolic dysfunction, reduce disease, and decrease mortality in men. Is it possible? Read on and find out.
Studies have clearly shown that low Testosterone in men is associated with an increase in all-cause mortality and cardiovascular mortality. But, is this association equal to causation? If low Testosterone was the cause of the metabolic dysfunction and disease then one would expect Testosterone therapy to resolve the metabolic dysfunction and disease. Two studies point to reduced mortality in men with Testosterone therapy. Both studies looked at Diabetic men with low Testosterone. The first study was published in the prestigious European Journal of Endocrinology and found that Testosterone therapy in men with document low Testosterone and type II Diabetes had a lower mortality rate (8.4%) compared to those untreated (19.2%). See the figure to the right. This is very significant as it reveals that Testosterone is not merely a biomarker of poor health, but can be a targeted therapy to improve health and reduce mortality in some men. Some is the operative word. There are many out there that feel no different on Testosterone therapy and worse–have complications from Testosterone therapy due to inadequate evaluation, poor working knowledge of hormone metabolism, and frank doping (most). The second study was published in the equally regarded Journal of Clinical Endocrinology and Metabolism. This study of 1032 men found a 10% mortality rate in men with Diabetes treated with Testosterone versus 21% in the untreated group. Again, a statistically significant reduction in mortality with Testosterone therapy in Diabetic men was found. One more study to highlight published in the Journal of Clinical Endocrinology and Metabolism. This study of 3069 men age 70-89 found those men with “mid-range” Testosterone and DihydroTestosterone levels were associated with lower mortality. Low Testosterone levels were associated with increased mortality. Above normal levels of Testosterone and DihydroTestosterone were not. More of a good thing is not a great thing: it is usually a bad thing.
Before we get to excited and claim Testosterone to be the panacea for men’s health, lets look at a recent meta-analysis. This study looked at 27 studies of 2,994 older men on Testosterone therapy for at least 12 weeks. The meta-analysis found that there was a 54% increase in adverse cardiovascular events in those men on Testosterone therapy versus those untreated. What was very interesting about this study was in the reporting of adverse events. The source of funding for the studies predicted the reporting of adverse events. Those studies funded by the pharmaceutical manufacturers reported less adverse cardiovascular events. Those studies that lacked this funding reported higher adverse cardiovascular events with Testosterone therapy. This is called bias and is rampant in the medical literature today. This bias clouds the scientific reliability of these studies. The risk of adverse cardiovascular events in this meta-analysis was 54%. The likelihood is that the risk is even higher due to the fact that the biased pharmaceutical funded studies would not want to report increased adverse events of a product that they then stand to profit from.
It is a balance. Some studies point to improvement in metabolic dysfunction and improvement in disease for some men. Other studies point to increased risk for other men. The key is customizing therapy to the individual–particularly to the cause(s).
Despite the positive findings for diabetic men with low Testosterone above, the best therapy to increase Testosterone levels, improve metabolic dysfunction and decrease disease risk is still weight loss in those men that are overweight and obese. This is no small number. With 75% of men expected to be overweight or obese by 2020 and 82% by 2030, the focus needs to shift to healthy living and away from just Testosterone. Yes, some men need Testosterone therapy as a part of their Wellness journey. Yes, in some men Testosterone therapy can have profound impact on metabolic dysfunction and disease. Unfortunately, Testosterone appears to be running the course of Human Growth Hormone (high regulation and limited access) due to overuse and misuse by medical providers. This wonder boy drug that Testosterone has become through marketing is simply history repeating itself.