A recent Veteran’s Administration study published in JAMA, the Journal of the American Medical Association, has received much media attention, raising fears regarding the use of testosterone replacement in aging men.The study had multiple flaws that limit its usefulness. Some of these flaws include:
- This was an observational study. These types of studies do not show cause and effect.
- Subjects in this study were relatively sick with advanced coronary disease.
- Only 60% of study patients received one follow up blood study to see if their blood levels had improved.
- Of those that had follow up testosterone levels, the average level was only 332 with the “normal range” being 250-1100. This could hardly be considered a therapeutic level.
The results of this study are contrary to the vast majority of studies supporting the benefits of testosterone replacement. Other studies using better methodology have concluded that:
- “In men with low testosterone levels, testosterone treatment was associated with decreased mortality compared with no testosterone treatment.” (Journal of Clinical Endocrinology and Metabolism, 2012)
- “…testosterone concentrations are inversely related to mortality due to cardiovascular (heart) disease and all causes.” (Circulation, the Journal of the American Heart Association, 2007)
- “In older men, lower total testosterone levels predict increased incidence of stroke or TIA (mini stroke) after adjusting for conventional risk factors for cardiovascular disease. Men with low-normal testosterone levels had increased risk.” (Journal of Clinical Endocrinology and Metabolism, 2009)
So what is the take home message?
- An overwhelming amount of medical literature supports the positive benefits of testosterone replacement, even in patients with coronary disease and heart failure.
- While the study raises the possibility that a subset of elderly patients with significant cardiovascular disease could conceivably have an increased risk of events, this risk could be minimized or eliminated by the use of 81mg of aspirin.
- Testosterone replacement should be given and followed by a physician experienced in its use.
- Testosterone replacement should be accompanied by lifestyle modifications to achieve maximum benefit.
As Cenegenics physicians, we strive to give you the latest information regarding our therapies. An example is putting studies like this into perspective. Not only do we want the best care for our patients, as patients ourselves, we want to be sure we are doing the right thing for our own health. You can count on Cenegenics for accurate, unbiased information. Our continued mission is to provide our elite patients with the best medical care possible.
Feel free to contact Dr. Popp or myself personally if you have any questions or need more information.
Mickey Barber, M.D.
843.577.8484 or 877-317-LIFE (5433)