Well, the media reports keep coming don’t they about how unsafe testosterone replacement therapy is? In case you have been asleep the past year or so there have been two studies that suggest testosterone replacement increases the risk of heart disease. We’ve addressed these poorly designed studies (one actually contained 10% women by mistake) already in this article. In fact, several studies done on testosterone over the past 70 years show that testosterone has a beneficial effect on cardiovascular disease.
Here’s a recent video from Good Morning America discussing the dangers of testosterone.
So if testosterone is really dangerous shouldn’t we consider castrating men? I’m not suggesting that we do, but the title of this article is intended to stimulate some thinking among those critical or leery of testosterone therapy – if testosterone is bad shouldn’t we do something to lower it then?
Vast Majority of Physicians Have No Training
There isn’t anything inherently dangerous with testosterone at physiologic levels. Of all forms of hormone replacement testosterone replacement therapy (TRT) is the most complicated and challenging, though. The risks that you read and hear about are largely the result of inadequate monitoring – even in clinical trials.
Testosterone gets converted into two other hormones; estradiol (estrogen) and dihydrotestosterone (DHT). Both estradiol and DHT can increase cardiovascular risks in men if levels of either get too high. The sad reality is that the people conducting some of these clinical trials have little practical experience prescribing testosterone and they are not measuring estradiol and DHT levels their studies. There are ways to lower estradiol and DHT if necessary. Also, testosterone can increase red blood cell production and there is a theoretical risk for strokes and heart attacks if blood counts get too high (simply treated by donating blood periodically).
Unfortunately, this lack of proper monitoring when it comes to testosterone therapy is prevalent across the country. Most prescriptions for testosterone are being written by physicians who have no formal training in TRT. Most of these are family medicine and internal medicine doctors. Many times men get a prescription for testosterone with little follow-up outside an occasional testosterone level and PSA level. What I just shared with you about estradiol and DHT most physicians don’t even know. Even the package inserts make no mention of monitoring DHT and estradiol levels.
In one of the two recent studies testosterone levels following treatment were not even obtained, and in only 60% of the men in the other study were testosterone levels measured during treatment. And, neither study measured estrogen or DHT levels.
Should We Lower Testosterone Levels?
So for those who claim testosterone is dangerous including the law firms that run ads on TV, why are they not advocating testosterone levels be lowered? I suggest they be the first to have their testosterone lowered.
Do you want to know what the effects are of lowering testosterone? We have a whole group of men out there who have been castrated – not surgically – but medically for prostate cancer. Guess, what happens to men who have been medically castrated? They get MORE HEART DISEASE and MORE STROKES. They also get MORE DEPRESSION. We’ve written about these negative effects from testosterone lowering treatments in this article.
Testosterone Therapy is Safe: If You’re Monitored
The problem, therefore, with testosterone replacement therapy is not testosterone. The problem is inadequate monitoring of patients receiving treatment. Seventy years of medical literature strongly indicate that testosterone therapy is safe for men with symptoms of low testosterone or androgen deficiency, but they need to be closely monitored by an experienced physician.
If you are a candidate for for testosterone replacement therapy we recommend you not be treated by a physician who is not going to monitor PSA, CBC, estradiol, and dihydrotestosterone (DHT) levels on a regular basis.