Testosterone Therapy: Terrific or Terrible?

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OVERLAND PARK, Kan. --Men are turning to testosterone therapy like never before to boost energy, attention and sex drive. But is T terrific or terrible?

Robert Coker is buff at age 52. But not long ago, you wouldn't have found him at Lifetime Fitness.

"I didn't have the energy to get up and go to the gym in the mornings," said Coker.

Coker said blood testing at Midwest Restorative Healht revealed he had low testosterone. The clinic is part of the burgeoning business of T therapy. Testosterone comes in prescription patches, gels, shots and pellets. Pellets are used at the clinic where Coker is treated. The pellets are implanted through a small incision every three months.

"They're designed to kind of dissolve into the bloodstream over the next three months," said Dr. Jim Staheli.

The doctor said raising testosterone can lift energy, brain fog, muscles and sex drive. Coker said it's sort of a fountain of youth.

"Puts me in the feeling of the age range between 25 and 40 years old. I recommend it to just about any male," said Coker.

Dr. Staheli said it's about treating individuals who are sick.

"By sick, I mean they're experiencing symptoms of low T," said Dr. Staheli.

A sickness? Dr. Ajay Nangia of the University of Kansas Hospital disagrees.

"Low testosterone is representing a general decline in our health and not the cause of our declining health," said Dr. Nangia.

He says inactivity, lack of sleep, poor diet and other factors lead to obesity which can lower testosterone levels.

"And many times, if you fix those, quess what? The original problem which is energy, libido even, can improve," the K.U. urologist said.

Dr. Staheli said those issues are addressed with men who come to the clinic where he practices.

"There isn't a patient who goes through here that we don't spend time with them going over those very things," Dr. Staheli added.

So what's the harm in taking T? Kevin Larson thought it was terrific. His family practice doctor prescribed shots to boost energy and help him lose weight.

"I dropped 50 pounds within about six months," said Larson.

About the same time, Kevin and wife, Sarah, were trying to give son, Casey, a sibling, and not succeeding.

Kevin saw Dr. Nangia who dropped a bombshell.

"Men who are still in their reproductive years, who still want to have children should not, repeat not, be put on testosterone," said Dr. Nangia.

The hormone that men take to increase virility decreases fertility. It lowers sperm counts. Dr. Nangia says one out of 10 men he sees with fertility problems are taking testosterone. His research shows when you stop T therapy, sperm counts skyrocket.

And guess what happens? The Larsons welcomed little Charlie three months ago. Kevin says beware of testosterone therapy. It doesn't suit every man to a T.

Dr. Nangia is concerned that many men are being prescribed T who haven't even been tested for low T, and don't have it. He said you need two blood draws done in the morning to prove it's low.

A study published this week in the Journal of the American Medical Association found T therapy raised the chances of heart attacks, strokes and death in older men, many of whom had known heart disease.

According to Mayo Clinic, testosterone therapy may:

  • Contribute to sleep apnea - a potentially serious sleep disorder in which breathing repeatedly stops and starts
  • Cause your body to make too many red blood cells (polycythemia), which can increase the risk of heart disease
  • Cause acne or other skin reactions
  • Stimulate noncancerous growth of the prostate (benign prostatic hyperplasia) and possibly stimulate growth of existing prostate cancer
  • Enlarge breasts
  • Limit sperm production or cause testicle shrinkage

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  • nelson vergel

    The VA study showed that 40% of patients did not have their testosterone blood levels retested after they started testosterone. This lack of follow up contradicts a review of guidelines published on 2011 by the American College of Cardiology Foundation that The Endocrine Society, the American Association of Clinical Endocrinologists, the American Society of Reproductive Medicine, and the European Association of Urology recommendations of monitoring patients’ blood analysis 3 months after initiation of testosterone therapy to determine testosterone replacement (TRT) dose adjustments and potential side effects.

    A previously study also published in JAMA in 2009 showed that men with total testosterone blood levels below 550 ng/dl had a significant increase in their risk of cardiovascular disease, while men with levels above 550 ng/dl reduced their risk by 30%. Monitored participants in the VA study were only able to increase their total testosterone blood levels to 332 ng/dl, a value considered sub-optimal by all testosterone treatment medical guidelines.

    Another shortcoming of the VA hospital system’s TRT protocol highlighted by the study is the lack of monitoring and managing of hematocrit (red cell volume) and estradiol (a female hormone produced in the body from testosterone). TRT can increase hematocrit and estradiol is a minority of men resulting in increased blood viscosity and cardiovascular risks as documented in the previously mentioned 2009 JAMA study. Fortunately, both variables can be easily managed if patients are properly monitored.

    The majority of participants in the VA study used testosterone patches. Once a popular method of testosterone delivery, testosterone patches are no longer used due to their poor absorption and inconvenience. This is reflected in the VA study where most of the participants continued to have testosterone deficiency and increased cardiovascular risk.

    Publishing flawed studies only increases the current misconceptions surrounding this important therapy and unnecessarily alarms TRT patients and their physicians.

    My education and advocacy men’s health group (ExcelMale) urges the VA hospital system to revise their TRT protocol and to follow current testosterone guidelines. We want only the best for the men who have served our country

  • Melanie

    If you are going to get any type of therapy done you should always monitor the levels. Fertility should have been something his physician should have went over with him before he even started treatment.

    Obviously when you are treating anything like hypogonadism which is still new to treatment, there are going to be new studies out. The Low T Center, a newer treatment center that specializes in TRT is an example of someone that is doing it right. They do retests every 90 days making sure the patient is on track with treatment.

    You can’t put something down so much if it is helping so many people out.

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  • Darin Mason

    Testosterone Replacement Therapy can prevent or reduce the likelihood of developing Diabetes, Cardiovascular Disease, Obesity, Osteoporosis, as well as Depression and Anxiety. Other studies have shown that long-term use of testosterone (7-10 years) was effective in maintaining bone density and muscle mass. What I consider the “Holy Grail’ of testosterone research came out in 2015, involving over 83,00 European veterans with low testosterone.

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