Men with Low-T: don t buy the testosterone-supplement hype

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Sales of testosterone supplements have skyrocketed by over 5-fold over the past decade, with 5.3 million prescriptions written in 2011. While it s true that, for men with signs and symptoms of low testosterone (T), therapeutic replacement may have beneficial effects on sexual function, bone mineral content, lipid levels and body fat, a new JAMA study is cause for concern.

Researchers led by Dr. Rebecca Vigen of the University of Texas/Southwestern Medical Center, Dallas, and others from the University of Colorado retrospectively analyzed clinical outcomes among 8,709 men who had low T levels and also underwent coronary angiography between 2005 and 2011. The data were obtained via the VA system.

Among this group, 1,223 men were started on T-supplements. In summary, the men who got T had a rate of CVD events (heart attack, stroke, or cardiac-related death) of 25.7 percent, compared with a rate of 19.9 percent in the no-T group. This represents a 30 percent increased risk among the T-users. Interestingly, there was no difference in effect between those men with CAD on the coronary artery study vs. the men without significant CAD (coronary artery disease).

Quoted in MedPage Today, Dr. Steven Nissen, a well-known cardiologist from the Cleveland Clinic and a frequent critic of Big Pharma, had this to say: [This study] demands attention not just from physicians but also from regulators. Testosterone replacement therapy ¦is increasingly commonly prescribed and largely fueled by direct-to-consumer advertising that's urging men to get tested for low testosterone and then to seek replacement." His concern was focused on the consequences: that clinicians feel compelled to treat a biochemical problem -- low levels of testosterone -- and that treatment could trigger a "clinical problem that's far more grave, which is coronary heart disease." He pointed out that a "fall in hormone levels in both men and women is a normal part of aging; it is not necessarily a disease. Making it into a disease may end up causing more harm than good."

ACSH's Dr. Gilbert Ross, while in essence agreeing with Dr. Nissen's comments, added this: "While this is clearly a warning signal to doctors to not administer T-therapy cavalierly, and to patients as well to not request it based on a TV ad or an aging libido, there are documented benefits to raising a man's T-level if it's significantly low. I wouldn't dismiss the whole topic because of this one study."