Hormone Therapy for Men: the Myths
Perhaps no greater myth exists in medicine than those related to hormone therapy for men.
“The great enemy of the truth is very often not the lie — deliberate, contrived, and dishonest, but the myth — persistent, persuasive, and unrealistic. Belief in myths allows the comfort of opinion without the discomfort of thought.” John F. Kennedy – 1962 Yale Commencement Speech.
Myths surrounding hormone therapy for men are many. Unfortunately physicians with little experience in the field of hormone replacement propagate many of these myths potentially denying their patients the many health benefits that can come from hormone replacement therapy. Let’s take a look at three myths.
MYTH 1: Age-Related Decline in Testosterone Does Not Require Treatment
Well, if that is true why treat anything in medicine that is age-related like poor vision or hearing and arthritis? In fact, most chronic diseases like hypertension, diabetes, heart disease, and cancer are age related.
What is not fully appreciated is that numerous studies show that lower testosterone levels are inversely related to mortality from cardiovascular disease, cancer, and all cause mortality. Also, lower testosterone is linked to muscle weakness. The significant of this is overlooked. Many of our elderly no longer have the physical strength to get out of chair or walk up a flight of stairs. Poor muscle strength contributes to falls and fractures.
MYTH 2: Testosterone Levels Within the Reference Range Are Normal
The typical range for total testosterone is usually 300 ng/ml to 1000 ng/ml. This range is determined by statistical methodology, but it does not imply what a normal level is for a given individual. The range is determined by finding the mean testosterone level for the reference group and setting the high and low at two standard deviations. This means that only 2.5% of men can be diagnosed as having “low testosterone” if using reference ranges only. This is absurd when nearly every male over age 60 and many over 50 and even some over 40 suffer from some of the many symptoms related to low testosterone.
What we know is that testosterone levels decline after age 30, faster in some men than others. We also know that not every male starts with the same level when 30 years old. We also know that a male with a testosterone level of 500 ng/ml can have significant symptoms and a male with a level of 400 ng/ml might not have any symptoms. It might be wise to consider a “normal” level that level at which a male is not symptomatic.
Population based studies show that men with testosterone levels in the upper third of the reference range suffer less heart disease and less cancer than men with levels in the bottom third of the reference range. Using that as a guide a strong case can be made that for overall health an optimal testosterone for most men should be considered 700 ng/ml or higher.
MYTH 3: Testosterone Causes Prostate Cancer
This may be the biggest myth out there when it comes to hormone therapy for men. Logically, this does not make sense since prostate cancer is far more prevalent as men age and their testosterone levels decline.
This myth goes back to a study performed in 1941 in which one patient with existing metastatic prostate cancer was treated with testosterone in which it was concluded that his cancer must have grown/spread based on an equivocal laboratory test.
A review of 18 studies found no association between testosterone levels and risk of prostate cancer. Some studies actually report a lower incidence of prostate cancer in men with higher testosterone levels, and more aggressive prostate cancers occurring in men with lower testosterone levels. One percent of men being treated with testosterone will develop prostate cancer each year equaling the rate of prostate cancer development in men not receiving testosterone.
A recent study even suggests that it is not necessary to discontinue testosterone replacement in men receiving testosterone therapy who subsequently develop prostate cancer.
If you suffer from symptoms of low testosterone (see “Low Testosterone Symptoms”) and your doctor says it is “not your testosterone”, get a second opinion.
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