CLEVELAND, Ohio— For men who suffer from low levels of the testosterone, a report presented Friday at the Endocrinology Society meeting in Chicago brought good news: testosterone replacement therapy doesn’t increase the risk of heart attacks or stroke.
But while this is helpful information for doctors who are treating patients who are deficient in the hormone, they caution men experiencing what they believe to be symptoms of low testosterone against seeking a prescription from one of the many “low T” centers popping up in strip malls.
Instead, they recommend that testosterone should only be used under medical guidance and with blood tests to ensure the correct dosage.
“What we did was not the same as saying that testosterone can be widely used in aging men,” said Cleveland Clinic Cardiologist Dr. Steve Nissen.
The study, led by Nissen, was designed to determine whether aging men with heart disease were at higher risk of heart attack or stroke if they were treated for their low testosterone. The results were published Friday in the New England Journal of Medicine.
Men in the study had a very specific disorder and their testosterone levels were carefully adjusted said Nissen, who expressed concern that the public would misinterpret the results to mean that testosterone could be safely used across the board.
“There’s been a proliferation of ‘low T’ centers around the country where it’s been reported that as many as 50% of men that walk in the clinic walk out with a testosterone prescription,” said Nissen, adding that in many cases these clinics don’t even check blood testosterone levels.
And although the most recent study showed that testosterone replacement did not increase heart attack or stroke in a very specific and carefully monitored population,there were still notable adverse reactions including atrial fibrillation, blood clots in the lungs or legs, and an increased risk of kidney injury.
“If men want to consider testosterone, they should see an endocrinologist or a urologist who has some scientific background in understanding the treatment and it’s use, and not at a shopping mall center,” said Nissen.
In both men and women, the sex hormones estrogen, progesterone and testosterone decline with age, and often result in unpleasant physical changes. Reduced testosterone levels in men - sometimes referred to as manopause - can result in disturbances in sleep and appetite, loss of muscle mass, fatigue, hair loss, weight gain, depression and moodiness, sexual dysfunction and poor memory.
It seems logical then that hormone replacement could be a panacea to reverse these symptoms. “But we’ve been down that road once before,” said Nissen referring to the medical community’s sudden reversal of what was once unbridled enthusiasm for estrogen therapy in women.
In menopausal women, estrogen replacement was once touted as a quick fix for many of the same symptoms seen in men, and at the time was thought to safeguard against bone loss leading to osteoporosis. Thatwas until a 2005 study called the Women’s Health Initiative found that estrogen increased a woman’s risk of heart disease and breast cancer. “At the time that study was done almost all women were being offered estrogen at the time of menopause,” Nissen said.
While hormone replacement therapy still has its place, doctors are now much more aware that the benefits of hormone replacement come with downsides, and carefully weigh the age of the patient, and the need for symptom relief against additional health risks. And that sort of caution is just as important in men as in women.
“Men are very vain,” said Nissen. “But this is not an antidote to aging. It’s a drug for the treatment of a disease.”