Is testosterone safe?
Testosterone gives us energy, boosts our muscle mass and bone strength, boosts insulin sensitivity (which is the opposite of diabetes), reduces body fat, and gives us more energy.
As we age our testosterone levels decline. Typically, there is an average annual reduction in free testosterone of 2%. However, the healthier you are, the less the reduction.
What is testosterone deficiency?
Some call testosterone deficiency “andropause” mimicking the word menopause. Symptoms of deficiency include:
- hot flushes
- loss of libido
- a flat mood/depression
- erectile dysfunction
- urinary urgency and frequency
Testosterone deficiency has been associated with:
- isulin resistance and diabetes
- cardiovascular disease
- an increase in overall mortality
Bear in mind also that an association, as outlined above, is not the same as a cause and effect. It may well be that there is a U-shaped association between testosterone levels and mortality in that mortality is lowest in people with middle range testosterone and highest in those with very low or very high testosterone.
Testosterone therapy, sexual health and mood
The research on the effect of testosterone therapy on sexual health and mood is conflicting.
- Some data shows a small improvement in erectile function with no improvement in libido or satisfaction
- Some data shows possible improvements in mood but these findings are not universal across all of the research studies
Testosterone and bone density
A number of studies have looked at testosterone and body composition. The general results have been discordant. There seems to be a minor increase in bone mineral density but no proof of reduction of fracture risk.
Testosterone and prostate cancer
It has long been believed that testosterone drives prostate cancer. In fact, the treatment for prostate cancer is reducing testosterone levels. However, two reviews in 2010 and 2014, did not show an increase in prostate cancer risk.
Testosterone, obesity and cardiovascular risk
Obesity can lead to an apparent low testosterone by affecting how it is transported in the blood through a binding protein. This is not necessarily testosterone deficiency although it looks like it.
It may be the obesity itself with its link to insulin resistance, high blood pressure and an increase in bad (LDL) cholesterol that is responsible for the increase in cardiovascular disease rather than the lowered testosterone.
The low testosterone may be targeted unfairly here. There is conflicting evidence in human trials in terms of improvement in cholesterol, blood sugar metabolism and blood pressure.
Several studies have raised significant concerns about a higher risk of heart attack. Many studies have shown an increased risk of cardiovascular disease (heart attack and stroke) of the order of 30% to 50%, particularly in those studies that were not sponsored by the pharmaceutical industry.
A more recent study of 55,000 men earlier this year, where men had an average age of 54 years, showed a doubling of the risk of heart attack 90 days after filling an initial testosterone prescription.
How does testosterone increase cardiovascular risk?
Testosterone may increase your cardiovascular risk because it may lead to:
- an increase in blood pressure
- an increase in red blood cells making your blood more likely to clot
- an increase in platelet stickiness which is part of the clotting phenomenon with a blocked coronary artery
- a reduction in the healthy HDL cholesterol
So what do we make of all of this?
The consensus seems to be that only men with symptoms of testosterone deficiency should have their testosterone level measured. And, if low testosterone levels are found, this ought to be confirmed with a repeat blood test before therapy is considered.
If testosterone therapy is then given, normal levels are the treatment goal, not higher than physiological testosterone levels.
Testosterone is to be used with extreme care
Testosterone should be used in extreme caution in those with a history of heart disease or significant plaque in the coronary arteries.
Despite two reviews, and until more compelling data is available, we would still advise extreme caution using testosterone for those with a high risk of prostate cancer based upon a family history, a rising prostate PSA or prostate abnormality on palpation.
Testosterone should only be prescribed for men who truly need it, and close follow-up is critically important to ensure that you are not over treated.
There is no compelling data of any improvement in longevity. There are some significant concerns that testosterone supplementation could lead to an increased risk of heart attack.
The bottom line
Come and speak to our doctors here if you are contemplating testosterone therapy.