Androgen deficiency or hypogonadism is characterized by a decrease in serum testosterone levels and varying symptoms including decreased libido, erectile dysfunction, decreased muscle mass and strength, increased bodyfat, decreased bone density, decreased energy, depressed mood, and decreased vitality (Wang et al, 2008; Basaria, 2014). Fortunately, testosterone replacement therapy (TRT) can ameliorate many, and in some cases all of these symptoms. The question is, should a man get TRT?
TRT has been a controversial subject for many years mainly due to an ignorant medical profession, driven by a pharmaceutical industry that wants men to be physically debilitated and unhealthy. The unhealthier a population is, the more money big pharma makes. Fortunately, there is an increasing amount of evidence showing the overwhelming benefits of TRT and the serious adverse effects of hypogonadism in men.
There is considerable evidence some of the age-related risk of cardiovascular disease (CVD) is related to a decline in testosterone.
It’s common knowledge that a man’s testosterone levels decrease as he ages. It is also common knowledge that age is a risk of CVD. However, most people, including most medical providers do not know the relationship between low testosterone levels and CVD. Researchers have shown that men with CVD have significantly lower levels of androgenic hormones, but the relationship between the two is still unclear.
In one study researchers used 206 males from the Baltimore Longitudinal Study of Aging. Their androgenic hormone levels were measured for 33 years. The study hypothesized that androgenic hormones prevent CVD by reducing arterial stiffness. An increase in arterial stiffness is recognized as an early risk factor for CVD. An increase in the stiffness of larger arteries leads to a rise in systolic blood pressure which can cause left ventricular hypertrophy. Researchers found as testosterone declined with age, arterial stiffness increased. “Thus, testosterone replacement therapy in hypogonadal men, a common condition in the elderly, may have a salutary impact on arterial stiffness and perhaps on cardiovascular events.” (Hougaku et al. 2015)
Traish et al (2013) found testosterone therapy significantly reduced total cholesterol, low-density lipoprotein cholesterol, triglycerides, and increased HDL cholesterol levels. Moreover, testosterone treatment significantly reduced blood glucose and HbA1c levels while improving systolic and diastolic blood pressure. These findings strongly indicate that testosterone therapy improves the cluster of symptoms of metabolic syndrome, which may prove useful in decreasing the risk of cardio-metabolic diseases.
Haring et al (2010) looked at the cause of death in almost 2000 men aged 20 to 79 years. The men with low testosterone at the start of the study had a 2.5 times greater risk of dying during the next ten years compared with men with higher testosterone levels independent of numerous risk factors.
“Male hypogonadism now has a new spectrum of complications. They are mainly cardiometabolic in nature. Low serum testosterone levels are a risk factor for diabetes, metabolic syndrome, inflammation, and dyslipidemia. These metabolic and inflammatory complications are not without consequences. Recent studies have shown low serum testosterone levels to be an independent risk factor of cardiovascular and all-cause mortality. It is time to welcome low serum testosterone levels as a cardiovascular risk factor (Haring et al, 2010)”
That low testosterone and obesity
Many obese men have decreased levels of free testosterone and total testosterone and an increased estrogen level. The more obese a person is the greater the hormone imbalances. By inhibiting estrogen production and increasing testosterone production one can get rid of the hormonal condition that contribute to weight gain. (Zumoffa et al, 2003)
Testosterone replacement therapy (TRT) has been controversial because of concerns it raises the risk of prostate cancer.
However, the following studies conclude testosterone replacement therapy is safe for prostate patients. A study evaluated the effects of testosterone therapy for 12 months in patients who showed pre-cancerous or normal prostates. Researchers from Beth Israel Deaconess Medical Center in Boston, who performed the study, found that testosterone therapy did not promote prostate cancer, even in men with a pre-cancerous condition. (Rhoden & Morgentaler, 2004)
Kaplan et al (2014) reported that 149,354 male subjects, including 1181 men who received TRT after a diagnosis with prostate cancer. Overall, TRT was not associated with overall or cancer-specific mortality. Pastuszak et al (2013) similarly stated that 103 men treated with TRT after their prostatectomy had an overall increase in serum PSA, but no evidence of increased cancer recurrence over 36 months.
Another study of 1365 men aged 28 – 87 with symptomatic hypogonadism receiving testosterone replacement therapy were monitored for up to 20 years. There were fourteen new cases of prostate cancer after 2966 man-years of treatment, which is 1 case per 212 years. Researchers concluded the incidence of prostate cancer during long term treatment for TRT was equivalent to the general population. More-over, testosterone replacement therapy with regular monitoring may be safer for men than any other alternative. (Feneley & Carruthers, 2012).
Bottom line, TRT is a personal choice. Do as much research as you can. And find a practitioner that has done their homework and is willing to answer all your questions.
Michael Furci is a Family Nurse Practitioner at Tenpenny Integrative Medical Center. To schedule a free consultation or make an appointment call (440)239-3438.
References
Basaria S. (2014) Male hypogonadism. Lancet 383, 1250–1263. DOI:https://doi.org/10.1016/S0140-6736(13)61126-5
Feneley, M. R. & Carruthers, M. (2012). Is Testosterone Treatment Good for the Prostate? Study of Safety during Long-Term Treatment. Journal of Sexual Medicine, 9(8). DOI:10.1111/j.1743-6109.2012.02808.x
Haring, R., et al. (2010). Low serum testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20–79. European Heart Journal, 31(12), 1494–1501, https://doi.org/10.1093/eurheartj/ehq009
Hougaku, H., et al. (2005).Relationship between androgenic hormones and arterial stiffness, based on longitudinal hormone measurements. American Journal of Physiology Endocrinology and Metabolism, 290(2), E234–E242. https://doi.org/10.1152/ajpendo.00059.2005
Kaplan A., et al. (2014) Testosterone replacement therapy following the diagnosis of prostate cancer: outcomes and utilization trends. J Sex Med 11(4):1063-1070. DOI: 10.1111/jsm.12429
Pastuszak A., Pearlman A., Lai W., Godoy G., Sathyamoorthy K., Liu J., et al. (2013) Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy. Journal of Urology, 190(2), 639-44
Rhoden, E. L. & Morgentaler, A. (2004). Testosterone Replacement Therapy in Hypogonadal Men at High Risk for Prostate Cancer: Results of 1 Year of Treatment in Men With Prostatic Intraepithelial Neoplasia. The Journal of Urology, 170(6), 2348-2351.
Traish, A. M., Haider, M., Doros, G., Saad, F. (2013). Long-term testosterone therapy in hypogonadal men ameliorates elements of the metabolic syndrome: an observational, long-term registry study. The International Journal of Clinical Practice https://doi.org/10.1111/ijcp.12319
Wang C., et al. (2008). Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. European Journal of Endocrinol, 159, 507–514. DOI: 10.1530/EJE-08-0601
Zumoffa, B., Miller, L. K ., & Strain, G. W. (2003). Reversal of the hypogonadotropic hypogonadism of obese men by administration of the aromatase inhibitor testolactone. Metabolism, 52(9), 1126-1128. https://doi.org/10.1016/S0026-0495(03)00186-0