02 Dec Testosterone – The Good and the Bad

Management of Testosterone Deficiency remains extremely controversial.  A recent Canadian task force reviewed all the literature available on the topic from 1/09 – 4/14.  This is the best review of testosterone supplementation that I have found.  A summary of their findings is listed below.

Symptoms that low Testosterone levels can present with –

1.  Sexual symptoms – Decreased Labido, erectile dysfunciton, decreased morning erections

2.  Somatic (physical complaints) – Increased organ and body fat, decreased lean muscle mass, decreased strength, fatigue (this is often the earliest symptom), decreased bone mineral density (bones get weaker), anemia, decreased facial, axillary, and pubic hair

3.  Psychologic – Depression, irritability, Insomnia/sleep disturbances, and inability to concentrate

If symptoms are present and Testosterone level low, consider treatment.  It is not recommended that low Testosterone levels be treated if no symptoms are present.

The role of Testosterone in Cardiovascular disease is one of the most contentious issues.  The American Academy of Clinical Endocrinology came out with this statement – “There is no compelling evidence that Testosterone therapy increases or decreases Cardiovascular risk.”  The benefits and risks of Testosterone replacement therapy are simply not well established in aging-associated hypogonadism.

Data does exist that low Testosterone may lead to increased Cardiovascular events and all cause mortality.  Low fat mass, increased muscle mass, and decreased insulin resistance are all, to some extent, protective against Cardiovascular disease and Testosterone promotes all of these.

So with all of that, who should be considered a candidate for Testosterone replacement therapy, and who should avoid it?

1.  Patients with stable Cardiovascular Disease are considered acceptable.

2.  Patients who have been treated for Prostate Cancer but have not metastatic or active disease are candidates.

3.  Patients with mild to moderate symptoms of Benign Prostate Hypertrophy can consider treatment.

4.  Men with Breast Cancer should not receive Testosterone therapy.

5.  If a man wants to maintain fertility, he should avoid Testosterone therapy.

6.  If a man’s testosterone levels are in the low normal range and he has some of the above symptoms, a trial of Testosterone therapy can be considered.

For follow up, the Task force did recommend checking a PSA, Hematocrit (blood level – since Testosterone can increase production of blood cells), and a Digital Rectal Exam 3 months, 6 months, and then Annually after starting Testosterone Therapy.

Everyone’s situation is different and should be base on an understanding of both the benefits and risks.

Here’s to the Journey!

(David W. Ball, MD, an Internal Medicine physician, founder of NuVitality Health – a wellness education company, and co-founder of Life Changing Fitness – a fitness facility for Every Body)