What are the benefits and risks of testosterone therapy? Studies investigate

Cody PriceFeb 25, 2017

The loss of this sex hormone could spell negative health effects, making some male patients undergo this therapy to replenish its levels artificially. When it comes to men's health, it is considered to be essential.

But, Dr. Bradley Anawalt said, taken together, all the Testosterone Trial findings show that testosterone could be a reasonable treatment for older men suffering more than one condition related to low T. Anawalt is a professor of endocrinology at the University of Washington in Seattle and a member of The Endocrine Society's leadership council.

The T Trials were conducted at 12 sites across the country in 790 men age 65 and older with low levels of testosterone and symptoms to which low testosterone might contribute.

Indeed, another trial published Tuesday, which was not part of the TTrials, showed a lower risk of cardiovascular events, including heart attack or stroke, in men who'd received testosterone, on average, for 3.4 years. In addition to low testosterone, the presence of complaints such as low sexual function, difficulty in walking or low vitality was required for eligibility to participate in the trials. "At this point, clinicians and their patients should remain aware that the cardiovascular risks and benefits of testosterone replacement in older hypogonadal men have not been adequately resolved". But there are opposite claims. But the effectiveness of testosterone has been controversial.

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The use of testosterone-replacement therapy has almost doubled in recent years, from 1.3 million patients in 2009 to 2.3 million in 2013, according to the U.S. Food and Drug Administration.

Despite lack of clarity on testosterone therapy's safety and benefits, the number of men taking the hormone has soared in recent years. Low serum testosterone has been associated with lower hemoglobin levels and small studies have demonstrated improvement with testosterone replacement. The second study showed increase in iron levels. Testosterone therapy now carries a boxed warning of potential heart risks, mandated by the FDA. While these conclusions proved testosterone to be beneficial to the participants, testosterone treatment did not improve memory or any other measure of cognitive function. The studies were funded primarily by the National Institute on Aging (NIA), part of the National Institutes of Health. The fifth study is observational and examines the links between testosterone treatment and overall cardiovascular health.

NEIGHMOND: Again, large long-term studies are needed to see whether testosterone supplements actually increase incidence of heart attack and stroke.

Bone trial - The goal of this trial was to determine whether testosterone treatment would increase volumetric bone mineral density (vBMD) - the amount of mineral in bone - and estimated bone strength in older men with low testosterone. vBMD, a marker of increased risk for fractures, was measured in hip and spine at baseline and 12 months later. However, other studies have found mixed results on this.

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"The paper reporting the results of the first three trials published previous year was the first to show there were advantages to giving testosterone treatment to older men with low testosterone levels, and the bone and anemia trial results further support a benefit", said the principal investigator Peter J. Snyder, MD, a professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism.

Another study published in JAMA Internal Medicine that tracked heart health over a period of about three years suggests possibly not, but experts say it is too soon to be sure. Those looked at sexual function, physical activity and mood and found that sexual function and desire did improve significantly among men using the testosterone gel. Four of them delved on the effects on anemia, bone density, cognitive function, as well as coronary plaque buildup. So longer, bigger trials will be needed to sort out the risks.

FMI: You'll find all the studies mentioned - and the editorial - in the February 21, 2017, issues of JAMA and JAMA Internal Medicine.

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