Email communication from Dr Fred Pescatore 17 July 2015
I’m sticking by testosterone
Since I am a big believer in testosterone supplementation–yet STILL get so many questions about its safety–I wanted to discuss this fear-fueled debate a bit more.
Around 80 years ago, medical professionals learned that testosterone can enhance well-being, improve men’s sexual symptoms, boost energy, and more. But by 1941, reports that testosterone “activated” prostate cancer scared off a lot of physicians–and, shockingly, that fear has persisted to this day. Even though that “research” was based on impossible-to-interpret results in just one single patient.
Now, the good ol’ FDA is expressing concern over possible cardiovascular risks of testosterone treatment. In March, they issued a warning about this, advising that testosterone therapy not be used for “age-related” symptoms.
This latest, and needless, fear flare-up came from a study in which investigators analyzed records from 8,709 men in the Veterans Affairs health system who’d had coronary angiography and had low testosterone levels. At 3 years after angiography, they found that the absolute rate of stroke, heart attack, and death was 25.7 percent among men who had received a testosterone prescription compared with 19.9 percent in the untreated group.
These findings received enormous media attention, but there’s one problem–they were completely wrong. The correct absolute rate was actually lower by one half in the testosterone-treated group vs. the untreated group: 10.1 percent vs. 21.2 percent. Someone seriously fell asleep at the calculator here.
So the Journal of the American Medical Association had to start publishing corrections that admitted everything from data errors, to the fact that the “all-male” study was…10 percent women. Oops.
Even the FDA came as close as they ever would to an admission of egg-on-face, saying, “…it is difficult to attribute the increased risk for non-fatal MI seen in the Finkle study to testosterone alone…” To date, 29 medical societies have called for the bogus initial article to be retracted due to incorrect data. But it’s extremely hard to get people to listen to this type of retraction once they’re already scared (and needlessly so). It’s a wildfire effect, and the fear had already spread.
All the while, other studies have routinely shown positive effects from testosterone therapy, including these: low testosterone levels are associated with increased mortality, atherosclerosis, and coronary artery disease; mortality is reduced by one half in testosterone-deficient men treated with testosterone therapy compared with untreated men; and testosterone therapy (vs. placebo) has resulted in uniform improvement in a variety of cardiovascular risk factors (fat mass, waist circumference, insulin resistance).
Sounds like a wonder drug to me.
Sadly, many doctors have stopped prescribing testosterone due to all the controversy. I have not. We are even ostracized by our colleagues for doing so. But when used properly, I’ve seen testosterone therapy work wonders for my patients. Which is why I won’t let the mounting “controversy” scare me into stopping using it for my patients with low-T.
Yes, there are potential risks to testosterone therapy–like acne, gynecomastia, and peripheral edema, but the risks are not as dire as the experts want you to believe (and have no credible evidence for). At this point, there is no evidence that testosterone therapy increases the risk of cardiovascular disease or prostate cancer. In addition, I’ve noted how it can even help diabetics.
The bottom line: Testosterone therapy is an effective option for symptomatic men with low levels of serum testosterone. These symptoms include those of both a sexual (reduced libido) and non-sexual (fatigue, loss of energy, weakness, poor motivation) nature. Testosterone therapy not only can improve these symptoms, but has also been shown to improve general health. And that last part is a given, as we’re talking about a momentum effect. If you feel more energetic and motivated, you’ll be more apt to take that daily walk (which will offer quite a health boost on its own).
To learn in more detail about what normal T levels look like (largely based on age and sex), take a look at the Logical Health Alternatives newsletter I wrote at the beginning of June, titled “Safety of testosterone therapy backed by years of science”. Subscribers can access this issue-and the complete archive-by visiting www.drpescatore.com and logging in to the Subscriber area of the website. (If you’re not already a subscriber, you can sign up here.)