Don't ask your Doctor about Low "T" says the NYT

The NY Times today has an article about a subject much discussed here in Hobby Land, testosterone replacement therapy. It references a recent study linking supplemental “T” to heart attacks for some groups of men, like those with diagnosed heart disease and those who are just old. And there is plenty of evidence linking high “T” to increased rates of everyman’s favorite, prostate cancer. That is thought to be the reason why black men have more prostate cancer: they have higher levels of testosterone. These days when a correlation crops up that someone doesn’t like the implications of, they sing “correlation is not causation”, which is true but an absence of correlation probably does indicate indicate a complete absence of causation.

The interesting thing to me is that courtesy of the desire of the Big Pharma to make even more money, just like Saint Ayn the Selfish told them to, we are now conducting a massive experiment with millions of men taking supplemental “T” (and paying for it themselves) that should provide a whole lot of information about what various levels of induced testosterone do to the people experiencing them. So, a round of thanks, in advance, is due to all the Brothers who are offering themselves up as experimental test subjects.

The only problem is who is going to collect the data as to what happens to all the lab rats with credit cards. I am pretty sure that the personal injury attorneys will soon step in to partly fill the gap but something a little more scientific would be nice.

GM


Don’t Ask Your Doctor About ‘Low T’


Benjamin Marra
SANTA BARBARA, Calif. — A FUNNY thing has happened in the United States over the last few decades. Men’s average testosterone levels have been dropping by at least 1 percent a year, according to a 2006 study in The Journal of Clinical Endocrinology and Metabolism.

Testosterone appears to decline naturally with aging, but internal belly fat depresses the hormone further, especially in obese men. Drugs like steroids and opiates also lower testosterone, and it’s suspected that chemicals like bisphenol A (or BPA, commonly found in plastic food containers) and diseases like Type 2 diabetes play a role as well.

Men feel the loss. Clinical testosterone deficiency, which is variously defined as lower than 220 to 350 nanograms of testosterone per deciliter of blood serum, can cause men to lose sex drive and fertility. Their bone density often declines, and they may feel tired and experience hot flashes and sweats.

But “low T,” as the condition has been labeled, isn’t nearly as common as the drug ads for prescription testosterone would have you believe. Pharmaceutical companies have seized on the decline in testosterone levels as pathological and applicable to every man. They aim to convince men that common effects of aging like slowing down a bit and feeling less sexual actually constitute a new disease, and that they need a prescription to cure it. This is a seductive message for many men, who just want to feel better than they do, and want to give it a shot, literally.

The problem is that prescription testosterone doesn’t just give your T level a boost: it may also increase your risk of heart attack. It can add huge numbers of red blood cells to your bloodstream and shrink your testes. In some men, it increases aggression and irritability. Children who accidentally come in contact with the hormone can develop unwanted pubic hair and genital changes. Last week, a large study published in the journal PLoS ONE found that, within three months, taking the hormone doubled the rate of heart attacks in men 65 and older, as well as in younger men who had heart disease. The Food and Drug Administration has begun an investigation.

The number of testosterone prescriptions given to American men has tripled since 2001. Used clinically since 1937 and approved by the F.D.A. since 1953, testosterone is now administered in at least five forms, including patches, gels and injections. Three million prescriptions were written in 2012 for the market leader AndroGel alone. Sales of all testosterone-boosting drugs are estimated to have been $2 billion in 2012, and are projected to hit $5 billion by 2017.

Too many doctors are now writing testosterone prescriptions without even measuring the patient’s hormone levels, much less re-testing for confirmation and adjusting the dose after prescription. Up to a quarter of these prescriptions are dispensed without a blood test.

From a psychological perspective, this isn’t helping men. From a medical perspective, it’s devastating. In addition to the cardiac risks, prescription T can mean a permanent shut-off in men’s own, albeit diminished, testosterone production. In other words, once you start, you may well be hooked for life.
Instead of heading to the pharmacy to get their fix, men should address the leading cause of the problem. Losing weight is a tried and true way to naturally boost testosterone levels. According to findings presented at the annual meeting of the Endocrine Society in 2012, obese men who lost an average of 17 pounds saw their testosterone levels increase by 15 percent. In general, a man’s waist should be half his height.

Some diet changes may be useful for reasons other than just weight loss. If you drink too much booze, switch to water — alcohol lowers testosterone levels. Eating more cruciferous vegetables like broccoli and collard greens can also help, by blunting the effects of estrogen in a man’s body. At the end of the day, eating more of the right foods and fewer junk foods improves mood and energy — which may be the only fix many men need.

In the 1990s and early 2000s, middle-aged women went through their own hormone trial, taking synthetic prescription estrogen and progesterone to treat the symptoms of menopause, among other reasons. But by 2002 we knew that those hormones raised the risk of stroke, heart disease, life-threatening blood clots and invasive breast cancer in healthy women.

Luckily, we don’t have to wait 12 more years to learn about the risks of testosterone in healthy men. Men have been drugged by overprocessed foods and gender-bending chemicals like BPA. The last thing they need now is a prescription for a risky drug to treat a trumped-up disease.

http://www.nytimes.com/2014/02/04/op...it_ty_20140204

Lots of comments as well,of course, including this one:

Jersey Mom New Jersey 10 hours ago
I am a family physician. Insurance companies used to insist we check testosterone levels and correct that first before approving ED medications such as Viagra. I found that correcting the testosterone level was not nearly as helpful as the drug companies claimed. Most saw no increase in energy or libido and was minimally helpful for ED. In the last few years, I've had many patients who asked to be checked for 'low T'. I carefully discussed the possible risks before the patients with low testosterone started it. Most patients who chose to try it also told me they felt little difference in how they felt with 'normal' testosterone. Many chose to stop due to cost. I am now convinced the 'low T' ads are mostly hype. I am also concerned about the effects of testosterone on BPH and prostate cancer... Like Dr.La Puma says, I think these patients would benefit more from weight loss and healthier lifestyles.

And this one:
EN Houston, TX 26 minutes ago
The article doesn't mention that low-T therapy increases the risk of developing prostate cancer. The MD Anderson protocol concerning normal testosterone ranges is:


Reference Ranges:

Male: Age 20 - 49 249 - 836

Age >=50 193 - 740


Female: Age 20 - 49 8 - 48
Age >=50 3 - 41


They are not fans of low-T therapy unless the T-level is far lower than the reference range.

(Notice that women have testosterone and men have estrogen, both normally, at low levels and with an as yet poorly understood role in complicated thing we call sexuality and sex roles. GM)

And my personal favorite:
Eric NY 26 minutes ago
It's a scientific fact that high-T makes men testy.

Sounds like I need to skip the buffet, dust off my Planet Fitness card, and hit the treadmill.

sixx

I find that concentrating on the "Low Y" does more for me.

I have been on a Bio-Compound of Cypionate 150mg now for 13 months, I feel like I am 25 again!!!

My Dr gets it out of Ca. due to there being so few Bio-Compound Pharmacies out there..for a few months last summer they switched Pharmacies and sent me some Synthetic Cypionate in the mean time, was worthless!!

So if you do this ask your Dr for the Natural Bio-Compound

If you live with women and are using testosterone, they are likely to get testosterone contamination.

Low T , depending I suppose on how low, can lead to bone density loss in men just as hormonal changes can lead to it in women. No doubt there is too much hype now in the media re: the low T phenomena, but there are legitimate cases where T supplementation might be necessary. For example, there is a condition called "empty sella syndrome" which is a pituitary condition resulting in low T. I have that, my T was way below normal and I use a T cream daily. I keep in close touch with my endocrinologist and have biannual lab work done. No problems so far and my bone density has improved. Of course, I exercise and lift weights and have the best physique I have had in years.

So, sometimes T supplementation my be necessary. Now, let me add, as a pharmacist it dismays me that T supplements are prescribed and the patient does not know why his T is low. I was fortunate to have a doctor who investigated.

I always advise folks of the side effects, and yes, I warn them that they may get a feeling, like I did , of invincibility, just sit on it.

I would not do without my T.

If you live with women and are using testosterone, they are likely to get testosterone contamination.


I would prefer to say "It's possible", not "likely"