Is treating "low T" really safe and effective

A pharmaceutical marketing blitz during treatment promises "low T" with a boost testosterone prescription daily are men with age-related decline of this hormone are more alert, energetic, mentally strong, and fully functioning the bedroom. 

But in an article published this week in the New England Journal of Medicine Perspectives section, an FDA scientific panel reiterated its concern over the widespread use of testosterone supplements in light of the unresolved controversies about its effectiveness and the long-term security.

Is a testosterone replacement therapy (TRT) delivering what these people expect? Dr. Christine P. Nguyen, one of the authors of the article, said that just do not know yet. "The benefits of testosterone therapy has not been confirmed for the treatment of men with low testosterone levels due to aging, even if the symptoms appear to be related to low testosterone," she said.

The increase in testosterone 
While the debate on Smolders safety and efficiency, the company is thriving even testosterone. In 2013, 2.2 million American men were on testosterone drugs, and 80% of them were between 40 and 74. Some suffer from verifiable health problems that cause testosterone levels to drop, as the testicles poor operation or tumors of the pituitary gland. No one disputes that these cases warrant testosterone therapy "classic hypogonadism" (especially if it begins to lose hair and hot flashes).

However, for most men in TRT, this is not the case. "The vast majority of men receiving testosterone requirements are now middle-aged men with higher levels of testosterone in the lower end of the normal range, or slightly below the lower end of the normal" says Dr. Shalender Bhasin, a leading testosterone researcher at Harvard-affiliated Brigham and Women's Hospital. "It is for people who have no clear evidence of benefit or safety."

Security Issues 
Concerns about whether testosterone supplements are safe for the heart recently moved to the FDA to require stronger warning labels on these products. But overall, long-term risks proof elements is mixed. Some studies have shown that men on testosterone have fewer heart attacks, strokes and death from heart disease. Other studies have found a higher risk of heart disease.

Frustratingly, there have been no studies to date designed to respond conclusively to this fundamental question. "It is an indication that [men] may have an increased cardiovascular risk, but are not conclusive by any means," says Dr Bhasin.

Bridging the gap 
To explore the issue of security in the typical users of TRT, Mr. Bhasin and his colleagues studied a group of 300 men, ages 60 and older, whose testosterone levels were either in the lower end of normal or healthy slightly below the male range adult. The men were randomly assigned to each rub testosterone gel or placebo gel daily. The team published its findings August 11 in the Journal of the American Medical Association.
 During and after the study, the researchers used several tests to screen men of atherosclerosis or hardening of the arteries - a common cause of heart attacks and other cardiovascular problems. Over three years of using TRT, the arteries of men showed no worsening of atherosclerosis. In addition, the researchers used surveys to whether men thought their sexual function or quality of life in general improved in TRT. Polls showed no improvement.

Dr Bhasin stresses that this study does not prove that the TRT is safe for the heart; this would require a broader and more study. But at least in this group of typical users of TRT, boost testosterone did not produce some of the major benefits promised to men.

What do men?
It is particularly important for men with possible signs of testosterone deficiency for a complete evaluation before opting for a fee. The guidelines of the American Society of Endocrinology for the use of testosterone, Dr. Bhasin helped create, design the basics of good practice.

The guidelines, published in 2010, showed a number of "red flags" clear of hypogonadism, including decreased libido, erectile dysfunction, low sperm count, loss of hair and hot flashes. Other signs that might suggest a wider deficit of the hormone are lack of concentration and memory; feeling sad or blue; insomnia; decreased energy, motivation, initiative and self-confidence; decrease in muscle mass and increased body fat; and a decrease in physical performance or work.

However, most of these signs of testosterone deficiency is also common in older men who have normal testosterone levels, so "low T" can not be diagnosed based on symptoms alone. You should also check if your testosterone is low. But the tests themselves can be unreliable and difficult to interpret, so the blood levels of testosterone should be carefully evaluated, tested more than a day, and to test the levels of other hormones related to testosterone. "The record is not that expensive," says Dr Bhasin. "It's not like it costs thousands of dollars. However, testosterone prescribed somewhat blind. "

In fact, a study in the September 2015 issue of the journal Medical Care found worrying signs of inappropriate testosterone prescriptions in the VA medical system. Of the nearly 112,000 new prescriptions for testosterone given to men between 2009 and 2012 VA outpatient clinics, 16.5% of men testosterone is no measurement at all. Worse, some men have testosterone requirements, even if they had a medical condition such as prostate cancer, which usually stand in the use of hormone supplements.

"Men want a thoughtful discussion of the risks and benefits, and doctors can guide correctly on the basis of the guidelines" says Dr Bhasin. "Patients come to you for help with their symptoms, but did never had a situation where they went because I refused to give them testosterone. "
By: Daniel Pendick