Millions of men take testosterone supplements each year in the U.S. Low testosterone, or “Low T”, can manifest in a variety of symptoms including:
The most popular forms of testosterone are injections and gels. Pill forms are available but are not as effective.
Testosterone slowly decreases with age at a rate of 1.6 % per year beginning in one’s 30’s. A man with significant testosterone loss, however could signify a more serious health issue such as diabetes. So many physicians don’t hesitate when it comes to supplementing this vital hormone.
However, its not without its risks. Risks of testosterone therapy include:
This week the American College of Physicians released new guidelines on testosterone replacement.
They suggest to only use testosterone therapy when treating sexual dysfunction but not for the other aforementioned conditions as the evidence is not supportive.
ACP suggests that clinicians discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual function (conditional recommendation; low-certainty evidence). The discussion should include the potential benefits, harms, costs, and patient’s preferences.
ACP suggests that clinicians should reevaluate symptoms within 12 months and periodically thereafter. Clinicians should discontinue testosterone treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function (conditional recommendation; low-certainty evidence).
ACP suggests that clinicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone, as costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar.
They also prefer intramuscular forms over transdermal preparations due to cost.
In 2016 researchers found a 63% increase risk of blood clots within the first 6 months of testosterone therapy. These are deadly as they increase the risk of heart disease, stroke, pulmonary embolism and organ damage. They form in veins, deep veins, and thus have an obstructed path to reach vital organs and prevent blood flow. This is not the first time venous thromboembolism (VTE) has been linked to testosterone therapy. Back in 2014 the FDA recommended warning labels on testosterone products.
According to researchers at Icahn School of Medicine at Mount Sinai in New York City state the overall risk is still low, one case per 1000 men a year, but could be of huge concern for those at risk of blood clots. Lead researcher, Dr.Carlos Martinez, states, “Risk peaks rapidly in the first six months of treatment and lasts for about nine months, and fades gradually thereafter.” So a promising finding is the risk falls as time passes since therapy.
Study author Dr. Mark Creager states, “My advice is to review the patient’s underlying risk factors for VTE, and weigh that risk against the potential benefit of testosterone therapy,” Creager said. “These individuals should at least be made aware of the fact that their risk would be even higher with testosterone.”
This study was published online 11/30/2016 in the BMJ (British Medical Journal)
For years, men have voiced frustration when their medical providers insisted on a cardiac workup prior to initiating an ED prescription. Some thought it was because they’d have a heart attack during sex. But it’s not. Erectile dysfunction is a vascular issue, and if the vessels of the penis are compromised, how does one know his heart vessels aren’t as well?
Now in a recent study from John Hopkins School of Medicine found an increase risk of stroke, heart attack and cardiac arrests in those men who suffered from erectile dysfunction. Study author, Michael Blaha, professor of Medicine, states, “Our findings suggest that clinicians should perform further targeted screening in men with erectile dysfunction, regardless of other cardiac risk factors and should consider managing any other risk factors — such as high blood pressure or cholesterol — that much more aggressively.”
Last December, a study published in the Journal of Vascular Medicine, found the same risk factors leading to erectile dysfunction are also culprits in heart disease.
Risk factors shared by both erectile dysfunction and heart disease include:
Last year, researchers from Mount Sinai Medical Center, Florida International University and Baptist Health South Florida reviewed multiple studies and found a link between erectile dysfunction and compromised blood vessels whose endothelium (lining) demonstrated impaired vessel relaxation. This is necessary for both erections as well as blood flow to the heart and rest of the body.
Moreover carotid media-intima thickness, a marker of atherosclerosis, appeared to be correlated to erectile dysfunction as well.
Both studies remind us that if one bodily function is impaired, other organs may be quietly suffering the same impairment.
I like to credit the pharmaceutical companies that created erectile dysfunction drugs with saving millions of men’s lives as:
Young men aren’t immune to cardiovascular disease and need to be screened as well if they have issues starting or maintaining erections.