The truth behind those scary testosterone headlines

Today, I’d like to share the details of a recent study on testosterone therapy that got a lot of attention from the mainstream media.

This news caused a great deal of alarm among my patients. Because as I’ve mentioned in this space many times, I am a big proponent of testosterone replacement therapy.

But as usual, there’s the headline, and then there’s the truth. So, allow me to offer both before I explain why this new study won’t change the way I treat my patients.

First, the headline that’s been causing such a stir: According to the latest report, testosterone therapy may boost the risk of heart attack, stroke, and death by as much as 30 percent.

Now, you know how much I hate the FDA. But if that statistic were really accurate, testosterone would be withdrawn from the market faster than you can say “class-action law suit.” No question about it.

So what’s the real story behind this study? Well, I’m glad you asked. Let’s look at the truth lurking behind the numbers–starting with some details about the patients enrolled in this study.

For one thing, these were all men undergoing coronary angiography at a Veterans Affairs hospital. Now, I mean no offense at all to the VA system. But its patients generally aren’t the most health conscious as a group.

In fact, the rate of comorbidities in these men was staggering. Roughly 20 percent had a history of heart attack. A good half of them had diabetes. And more than 80 percent had coronary artery disease.

Obviously, these guys were already quite sick to begin with.

Anyone who doesn’t think this detail is significant should consider the results of previous research on testosterone replacement. For example, one recent study showed that men with low T benefited from significant improvements in cholesterol, blood pressure, and blood sugar levels after five years of replacement therapy.

So obviously the new headlines about cardiovascular risks don’t apply to every patient on T.

I have been prescribing testosterone replacement therapy for decades. Long before it was chic and trendy. And you know what? These are not risks that I have ever observed in a clinical setting.

Then again, I will gladly toot my own horn by differentiating myself as an expert on bioidentical hormone replacement. And it’s unclear whether most of the doctors prescribing this type of treatment can say the same.

So let me tell you what I told my patients the entire week after this study came out.

Testosterone therapy itself is unlikely to be the culprit behind any elevated heart risk. That said, we do know that testosterone can raise hematocrit levels, influence your body’s clotting mechanisms, and aggravate cases of sleep apnea.

These individual things can lead to an increase in cardiac events. That much is true.

Therefore, if you’re currently using testosterone therapy or are interested in doing so, always ensure that your doctor tests you for these other markers in addition to your testosterone levels.

These are routine precautions that I take with any patient who sees me. Because it’s the only way to manage treatment safely and appropriately.

The bottom line? As long as you’re well-monitored, there’s absolutely no need to worry about or stop your testosterone therapy.

“Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels.” JAMA 2013; 310:1829-1835.
“Testosterone therapy and risk of cardiovascular disease in men.” JAMA 2013; 310:1805-1806.
Testosterone Therapy Linked With Adverse CVD Events. Medscape. Nov 05, 2013.