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Testosterone Concerns

As a healthcare professional, you’ve no doubt heard the buzz about testosterone and “low T.”

Testosterone ConcernsIt’s normal for men’s testosterone levels to decline as they age. This decline leaves some men feeling run down and depressed. They may lose interest in sex and develop erectile problems.

It may be easy to suggest that low testosterone is the culprit. Testosterone is widely marketed and often touted as an elixir that can return youth and vitality to the middle-aged man.

Certainly there are benefits to testosterone therapy. It can improve muscle power and bone mineral density. For some men, mood, libido, and erectile function get better as well.

But testosterone therapy is not appropriate for every man. If your patients are thinking about taking testosterone, several concerns should be addressed:

  • Testosterone therapy may not be needed. Symptoms such as fatigue, decreased sex drive, depression, and erectile dysfunction could very well signal testosterone deficiency. But these symptoms might be explained by other conditions, too. It’s important for patients to have a thorough examination before testosterone is prescribed. Also, some symptoms may be alleviated through lifestyle changes, like improved diet and exercise, making testosterone treatment unnecessary.
  • Testosterone therapy may have risks. At the end of January 2014, the U.S. Food and Drug Administration (FDA) announced its plans to investigate the safety of FDA-approved testosterone products. This decision came after two studies raised the agency’s concern. The first study, published in the Journal of the American Medical Association (JAMA) in November 2013, found increased risk of heart attack, stroke and death among men who took testosterone after coronary angiography. The second, which appeared two months later in PLOS One, found that heart attack risk increased for men aged 65 and older and for men younger than 65 with a history of heart disease. (Younger men with no history of heart disease were not at increased risk.)
  • Study funding may skew results, making them difficult to interpret. In a Medscape slideshow presentation, Dr. Charles Vega of the University of California, Irvine points out that half of the clinical trials examining cardiovascular events and testosterone have been sponsored by the pharmaceutical industry. In sponsored trials, the rate of cardiovascular events is 4%. In non-sponsored trials, the rate is 8%.
  • Men may try over-the-counter testosterone products, which can be risky. Some men feel embarrassed to discuss their symptoms with a physician, especially if they’re having sexual problems. They may see advertisements for testosterone products or hear about them from friends. Ordering such products online or picking them up at the drugstore may seem like a good way to avoid going to the doctor. But over-the-counter products are not always what they seem. They may include ingredients that aren’t listed on the label. These ingredients may cause dangerous interactions with drugs the man is already taking. Over-the-counter supplements are not regulated by the FDA. In the United States, testosterone is a controlled substance and illegal to sell without a prescription. (For more details on the risks of over-the-counter testosterone supplements, please click here.)

So who should take testosterone and how should therapy be managed?

Dr. Vega makes the following suggestions:

Only symptomatic men should be evaluated for possible [testosterone deficiency], and [testosterone deficiency] should not be diagnosed without 2 morning testosterone levels that are unequivocally low. Serum testosterone levels should be reevaluated 3-6 months after the initiation of testosterone treatment, with the goal of achieving serum testosterone levels in the mid-normal range. [Testosterone therapy] should be prescribed only for men who truly need it, and these men require close follow-up to ensure that treatment goals are met and to avoid overtreatment. Caution is warranted in recommending [testosterone therapy] to men at high [cardiovascular] risk.

Testosterone therapy can do a lot of good. But it’s important to consider it in full context.


Print this article or view it as a PDF file here: Testosterone Concerns


Resources

Medscape

Black, Henry, MD

“When Men Want Testosterone, Show Them the Evidence”

(January 24, 2014)

http://www.medscape.com/viewarticle/819393?src=wnl_edit_specol

Vega, Charles P., MD

“Putting the ‘T’rouble in Testosterone Therapy?”

(January 30, 2014)

http://www.medscape.com/viewarticle/819766

Vega, Charles P., MD

“‘T’errific or ‘T’errible? A Review of Testosterone Deficiency”

(Slideshow. February 18, 2014)

http://www.medscape.com/features/slideshow/testosterone-deficiency#1

Sexual Medicine Society of North America

“FDA to Review Safety of Testosterone Therapy”

(February 12, 2014)

http://www.sexhealthmatters.org/news/fda-to-review-safety-of-testosterone-therapy

“Marketing Low Testosterone”

(May 29, 2013)

http://www.sexhealthmatters.org/news/marketing-low-testosterone

“Risks and Realities of OTC Testosterone Supplements”

(April 9, 2013)

http://www.sexhealthmatters.org/sex-health-blog/risks-and-realities-of-otc-testosterone-supplements