Testosterone Therapy in Men

Traditional symptoms of male hypogonadism (low testosterone or Low T) are well known. These include decreased libido (sex drive), erectile dysfunction, decreased muscle mass and strength, increased fat mass, changes in mood and energy, and osteoporosis. Low testosterone has been associated with an increased risk of all-cause mortality (death), strokes, diabetes and metabolic syndrome. Testosterone levels are inversely related to the degree of coronary atherosclerosis. In other words, the lower your testosterone levels the worse are the plaques in the arteries of your heart and vice versa.

Studies have shown that men in the highest tertile (third) for testosterone levels had a reduction of 60-80% of severe aortic atherosclerosis. Studies have also shown that systolic and diastolic blood pressures are inversely correlated with testosterone. Testosterone therapy improves exercise-induced myocardial ischemia (decreased blood flow to the heart).

A five year study out of Boston University School of Medicine published in 2013, showed testosterone treatment of hypogondal men decreased total cholesterol, LDL cholesterol and triglycerides, while HDL increased. The men also experienced a decrease in systolic and diastolic blood pressure, fasting glucose, HgbA1c, CRP (inflammatory marker) and liver enzymes. Restoring testosterone levels to physiologic levels produces important clinical benefits. It is cardiovascularly protective.

Long term testosterone treatment of men has been shown to produce marked and significant decreases in body weight, waist circumference and body mass index. Testosterone replacement also improves inflammatory markers. By doing so, it decreases the risks of heart attacks, strokes and diabetes.

A study published in Men’s Health 2016 from Intermountain Medical Center Heart Institute studied 775 male patients who had severe coronary artery disease. At the end of the first year, 64 patients who weren’t taking testosterone had serious adverse cardiac events, whereas only 12 who were taking medium doses of testosterone and 9 who were taking high doses did. At the end of 3 years, 125 men who had not received testosterone therapy suffered severe cardiovascular events, whereas only 38 medium-dose and 22 high-dose patients did. The non-testosterone therapy patients were 80% more likely to suffer an adverse event. Where would you like your testosterone levels to be?

These are just a few of the literally hundreds of studies that have been published over the past 40 years showing the benefits of testosterone therapy. But you may be asking then why did my doctor tell me that testosterone does the exact opposite or what about that JAMA article that was published in 2013? Let’s discuss that study briefly. First it was an observational study. That is exactly what it sounds like. People are observed and no interventions are done. You cannot prove “a” causes “b” just be observing it. In this case over 8000 male Veterans with low testosterone were observed. Some were given prescriptions for testosterone and some weren’t.

After 3 years, the group that was given prescriptions had 29% more deaths, heart attacks and strokes. Very little information about whether testosterone was appropriately prescribed was given in the analysis. As a matter of fact only 60% of the men given a prescription ever had their testosterone levels rechecked. There is no way of knowing if the men filled the prescriptions or if they reached physiologic levels of testosterone. The study was seriously flawed. One study does not negate the many other studies that show benefit. The studies published after this one also show benefit.

If you are suffering from low testosterone symptoms, please seek medical attention from a doctor trained in bio-identical hormone replacement such as myself. Your doctor should be able to tell you all of the risks, benefits and treatment options for testosterone.

Honored to be partnering with you on your journey to Aging Gracefully,

Michelle McElroy, DO