News at NCH
"Testosterone Supplements—Good or Bad" by Allen Weiss, MD, MBA, President & CEO

Testosterone Supplements—Good or Bad

April 1, 2014 - Testosterone supplementation in aging men is becoming more prevalent even as its use is becoming more and more controversial.

As we all live longer, many previously undiagnosed conditions have become more common and this is the situation for men with low testosterone. Simultaneously, we have become better at measuring changes in our blood chemistries and more demanding in our desires to feel well and perform better.

Thus, the medical diagnosis of “late onset hypogonadism,” probably affects 2 to 4 million American men. Treatment is given to only about 5% of men with this condition and even this low rate represents a substantial increase in percentage of men treated over the past few years.

Just as women undergo menopause, men can undergo male menopause or andropause. Specific signs and symptoms in older men include a decrease in muscle mass and strength, a decrease in bone mass with the onset of osteoporosis, and an increase in central fat. Namely the older male body changes shape as we get shorter and fatter. Not fun to talk about, see in the mirror, or look forward to but nonetheless reality.

Symptoms such as decreased libido and sexual desire, forgetfulness, loss of memory, anemia, difficulty in concentration, insomnia, and a decreased sense of well-being are more difficult to measure and differentiate from normal aging and andropause, according to an excellent review by Bassil, Alkaade and Morley entitled, “The Benefits and Risks of Testosterone Replacement Therapy: A Review.”

Testosterone declines at about 1% per year, starting gradually at age 30. Over the ensuing decades the rate of decrease accelerates. By age 80 over 30% of men are in the low range by laboratory tests. However, just being in the low range doesn’t make a diagnosis nor necessarily require treatment.

Having symptoms of low libido, erectile dysfunction, fatigue, poor energy level, difficulty concentrating, depression, irritability, low sense of well-being and other less well-defined conditions are necessary for the diagnosis. Again and importantly, just having a laboratory abnormality is not enough to necessitate replacement therapy. Treating the patient and not the lab is an old clinical saw which has held up well even as we have easier availability to a myriad of tests.

There are benefits and risks to treatment, which is usually the case with any medical condition. Benefits include improved mood, better energy, a positive sense of well-being, better sexual function, greater muscle strength and progression towards a leaner body mass. Bone density improvement and increased red cell count also have been observed.

Cognitive function, namely the ability to think, solve problems, and have a better memory, has been examined in relation to testosterone levels in the blood. No definitive correlation was found between poor memory and low testosterone, although the studies were relatively small and of short duration. Unfortunately, using testosterone replacement as a treatment for Alzheimer’s disease was also unsuccessful.

Lately, there have been new concerns about testosterone and an increased chance of heart attacks. There have been studies in the New England Journal of Medicine and the Journal of the American Medical Association showing the use of testosterone supplementation in men with low levels of that hormone had an increased risk for heart attacks. In frail older men with limited mobility and a high prevalence of chronic disease, there was also an increased risk for cardiovascular disease. This study, too, was small and limited to a specific group of frail elderly and not the general population.

Nothing is without risks in medicine. There are always pros and cons to taking any medication, but in general, avoiding an unnecessary medication is wise. However, symptoms of low testosterone combined with objective laboratory confirmation should be the first two specifics recognized, even before thinking about taking additional testosterone therapy.

The science of medicine is always evolving and now faster than ever. Stay tuned as more research findings are published about testosterone. In the meantime, let’s all remain open-minded about risks and benefits.


 
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Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.