Diabetic? Watch your T: Yet another compelling case for testosterone replacement

Once again, I want to bring up a topic I consider extremely important—testosterone replacement. Unfortunately it’s one that a lot of mainstream medicine robots consider “controversial.” (Despite the fact that these are the same people who have absolutely no problem prescribing statins and a number of other drugs that have been shown to be harmful to people’s health. Guess they get to pick and choose what’s “controversial” and what’s not.)

Anyway, let’s get to the new research, which is the reason why I’m revisiting this critical topic.

The study, published in the Journal of Clinical Endocrinology & Metabolism, found that men who have low testosterone and Type 2 diabetes have a greater risk of developing atherosclerosis (hardening and narrowing of the arteries) than men who have diabetes and normal testosterone levels.

Researchers looked at key markers of atherosclerosis (like the presence of plaque, the thickening of the carotid artery, and the functioning of the endothelial cells that line the heart and blood vessels), in 115 men with Type 2 diabetes who were younger than age 70 and—this is important—had no prior history of cardiovascular disease.

Researchers measured the participants’ testosterone levels. And found that more than half of the diabetes patients also had low testosterone levels.

Those low levels had a very big negative impact: The researchers found men who had low testosterone and Type 2 diabetes were six times more likely to have increased thickness of the carotid artery (and dysfunction in the endothelial calls) compared to men with normal testosterone levels. And 54 percent of the men with low testosterone (vs. just 10 percent of the men with normal testosterone) had significantly increased risk for vascular disease.

It doesn’t take a math genius to figure out that’s a huge difference.

I’ve written before about how distressingly prevalent low testosterone (or “low T”) is. Not only among those with diabetes, but in general. And even though the mainstream medical community loves to decry testosterone supplementation as “controversial” (just like they thought low-carb diets were), I’ve seen the positive changes it can make first-hand.

I’m astounded by how many of my patients suffer from low T. Yet I’m never surprised by the dramatic turnarounds these patients make once they start testosterone replacement therapy. My patients routinely tell me how they feel more alive, focused, and energetic when undergoing testosterone replacement.

Yet there’s still ongoing debate about the safety of this invaluable therapy. But the fact is, the vast majority of the studies raising red flags about testosterone replacement have had serious flaws. Like the recent one that claimed testosterone therapy increases heart attack risk.  It made national headlines in every major news outlet across the country. And appeared to affirm the so-called “experts’” dire warnings to avoid testosterone at all costs.

But a closer look at the fine print of this study revealed that the subjects were far from healthy to begin with. Around 20 percent had a history of heart attack, half had diabetes, and more than 80 percent had coronary heart disease. So it’s hardly fair to point the finger at testosterone as the culprit behind increased heart risk here.

I’m not saying we should entirely discount potential risk. I’m a responsible physician and take my patients’ safety very seriously. I’m always weighing pros against cons. Unfortunately, the health “authorities” in this country aren’t doing the same. And when it bad-mouths testosterone replacement therapy, the FDA seems to focus only on the statistics and study results that support its anti-testosterone stance. But the numbers they conveniently forget to share with the public are pretty startling. Like the number of men Low T affects—some 4 to 5 million (including half of older men with type 2 diabetes).

And how about this: One meta-analysis of a dozen studies showed that for every two-point deficiency in serum testosterone, there was a 35-percent increase in risk of death—and a 25-percent increase in heart-related death, specifically. Why isn’t the FDA interested in these numbers?

Here’s my bottom line, and I’ve said it before: Replace responsibly. Whenever you undergo any medical treatment or procedure, there are potential risks and rewards. When I see a patient for potential testosterone replacement, I weigh potential risks against benefits and make an informed decision based on that person’s particular situation. I do my research and carefully weigh each case. This is something that any doctor you consult needs to do. Testosterone replacement therapy should always be individualized. It’s not the same for everyone. I’m imploring you to find someone who knows this, and practices it on a daily basis.

Not sure where to start? The American College for Advancement in Medicine (ACAM) is a great resource for locating an experienced holistic practitioner in your area. Simply enter your zip code into their search engine at www.acam.org to find a list of physicians near you. These are the folks who know how to weigh risks and benefits, and treat you like an individual. And just like me, they’re able to give you the best chance of coming out feeling better than ever.


“Low Testosterone Concentration and Atherosclerotic Disease Markers in Male Patients With Type 2 Diabetes.” The Journal of Clinical Endocrinology & Metabolism, 10/16/14 (epub ahead of print)

“Diabetic men with low testosterone run higher risk of developing atherosclerosis.” ScienceDaily, 10/16/14