Defending Testosterone, Debunking the Myths. This is the name of an article that came out June 4, 2015, in Medscape, by Abraham Morgentaler MD, a physician and researcher looking at testosterone every which way for decades.
Dr. Morgentaler says that the effects of low testosterone called “hypogonadism” or “low T” and the benefits of treatment with T has been widely practiced for many years since testosterone replacement was first synthesized in 1935. But controversy has surrounded T therapy all these years.
This shadow of murk over T replacement was based on a single report, later shown to be unreliable, that testosterone caused prostate cancer. This created a halo of fear surrounding T in the same way the Women’s Health Initiative (WHI) did for women and estrogen. This non-science based fear has continued for 70 years up to today.
Dr. Morgentaler says “As a testosterone researcher for nearly 40 years, and as a clinician for more than 25 years specializing in men’s health, I have treated several thousand men with testosterone. Few topics in medicine elicit as much passion. Unfortunately, passion clouds our ability to assess the evidence on testosterone objectively.”
For some reason, reason has left the room regarding hormone replacement.
In March, The US FDA warned about testosterone’s risk in causing adverse heart disease risks. But Dr. Morgentaler goes on to cite the same studies I did in my blog on “The Testosterone Wars”. These T worries came out of Vigen and colleagues study published in JAMA 2013 when they analyzed 8709 men in the Veterans Affairs health system that underwent coronary angiography and had low testosterone levels. The primary findings were that the absolute rate of stroke, heart attack and death was 25.7% among men who had received a testosterone prescription compared with 19.9% in the untreated group at 3 years after angiography.
Scary news makes big headlines. This study was widely quoted. Many patients threw out their scripts and wives warned their hubbies.
But, as Dr. Morgentaler said this month, and I said several months ago, these interpretations were incorrect.
The correct absolute rate of events (number of adverse events divided by the number of individuals) was lower by one half in the testosterone-treated group compared with the untreated group. (Death by testosterone? We think not! J Sex Med. 2014;11:624-629)
To date, 29 medical societies have called for the retractions of some of the T damaging articles clearly stating they are not credible. This is huge. Almost 30 societies said this data on T is wrong! (Testosterone and cardiovascular risk: world’s experts take unprecedented action to correct misinformation. Aging Male. 2014;17:63-65)
Then the next misinterpreted study. Finkle and colleagues reported increased rates of nonfatal heart attacks shortly after having a doc write a man a script for T compared to having been off T the previous year. Reanalysis of this study showed how flawed it was. Even the FDA said we can’t draw these conclusions from this way of reading the data.
Folks have no idea how often, especially around hormones, studies get reanalyzed and are shown to be faulty. But the original scary headlines made the news and are near impossible to get out of the public and even physician psyche.
Or the new study is a rehash of an old study that was run on synthetic versions of hormones that we already know cause issues. But the new study reanalyzes the bad health effects as though this is new information looking like new issues have arisen with the hormones. But it’s old news. Or perhaps the statistician needed to publish or perish and resurrected this old data, in new light, same scary headlines, but not applicable to new hormonal protocols.
But the public doesn’t know this. Many docs may not know this. Women send me articles all the time sounding scary, but if myself and my colleagues read them, they are new version of older protocols already proven to be risky.
Yeech!
Physicians specializing in T or E replacement, often get criticized by their colleagues. You then ask them if you are a candidate for hormone replacement and they say “no”. They may be protecting their license more than your health. They may not know the reanalysis and the new detailed understanding of hormone safety. They understandably don’t want to lose their license and we all need to make a living.
It’s a conundrum. But all you hear is “no”.
Dr. Morgantaler and his staff published a systematic review of the scientific literature surrounding T and heart health that has gotten such bad (and not justified) press lately. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015;90:224-25.
Only four studies reported negative concerns, no proven issues including the two mentioned above. But as Dr. Morgentaler clearly points out, several dozen studies (and in science the TREND is everything) show clear positive effects of healthy T levels linked to healthy hearts in males.
Here is a summary these researchers give with the plus points of T and heart health:
- LOW T levels are associated with INCREASED mortality, plaque in arteries, and heart disease;
- DEATH is REDUCED by 1/2 in T-deficient men treated with T therapy compared to untreated men;
- Men with heart disease can EXERCISE MORE on T therapy compared to men on placebo;
- There is across the board IMPROVEMENT in heart disease risk factors (fat mass, waist circumference, insulin resistance) when men are on T therapy compared to men on placebo.
The weight of evidence, of many more scientific studies showing this GOOD vs. BAD, show the heart benefits of having a NORMAL or OPTIMAL serum testosterone concentration (not in the 200’s, or 300’s, or 400’s and for some men this even means much higher if not a tad over normal to feel GREAT) whether achieved NATURALLY (exercise, love-making, genes) or with testosterone replacement (scripts).
As I wrote in Safe Hormones, Smart Women, Dr. Speroff, the icon in women’s medicine, said, our culture is run by fear headlines, and so are our docs. Dr. Speroff said the same thing as myself and Dr. Morgentaler are proclaiming. Scary headlines sell news and many thus miss out on cogent health protective protocols.
For males, Dr. Morgentaler says, “Unfortunately, our culture is obsessed with risk, and “danger” makes headlines. Plaintiff’s attorneys advertise for men who had strokes or heart attacks to come forward to generate class action lawsuits.”
The way media presents hormones many men and women have been throwing the hormonal baby out with the hormonal bath water.
Dr. Morgentaler brought up the WHI himself. He says that the public would be surprised to learn that 2013 follow-up data from the WHI revealed significantly fewer cases of invasive breast cancer among women who took estrogen alone compared with women who took placebo. Menopausal hormone therapy and health outcomes during the intervention and extended post-stopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310:1353-1368.
Actually reanalyzes starting coming out from diverse prestigious institutions like Yale only within 1 to 2 years after the WHI, which is why I took three years out of my life to write Safe Hormones, Smart Women to keep women informed and safe! My book came out in 2010 (and a revision is headed your way within a year or so).
The point is: once headlines have screamed RISKS and DANGER, even if the facts are WRONG, it can take years (if ever) for the REAL facts to come out.
In the public’s mind. And in doctor’s scripts.
You as a patient may miss out unless you have a true GEEK member in your healing village.
Knowledge is power.
And there you have it.