Hormones are those chemicals that float around in our bloodstreams causing many and varied effects throughout our days and throughout our lives.
There has been a lot of study devoted to female hormones, especially since their levels radically decrease in general when ladies are around 50 years of age resulting in menopause. This causes many women to choose to take hormone replacement therapy, which has resulted in a mixed bag of results and recommendations.
The twists and turns in controversy regarding hormone replacement therapy in women may turn out to be no more complex than the path for the treatment of aging men.
There is now a passionate debate around testosterone replacement therapy for symptoms of “male menopause”. You have strong believers that it is really beneficial while others say the benefit is modest and not worth the risk.
After the publication of two articles linking testosterone replacement therapy with an increased risk for heart attacks and strokes, the U.S. Food and Drug Administration (FDA) and Health Canada issued warnings about using testosterone products for age-related low testosterone and required a warning on product labels. The European Medicines Agency, however, found no consistent evidence for such risks.
Prescribing patterns appear equally conflicted, with one recent study showing testosterone prescriptions plunging in 2013 after publications of the cardiovascular safety concerns. But another report found spending on testosterone nearly quadrupled from 108 million dollars in 2007 to 402 million dollars in 2016.
The rate of incidence of clinical pathology called hypogonadism, however, has remained stable, suggesting that aging but otherwise healthy men with low testosterone may be turning to testosterone replacement therapy (TRT) as an elixir for aging and dwindling sexual function. Perhaps you have seen the commercials about “Low T” advocating the use of testosterone supplements that the drug companies want men to buy for the rest of their lives.
Researchers are studying a large group of more than 15,000 men, aged 45 years or older (mean 60.4 years), diagnosed with low testosterone without evidence of hypogonadotropic or testicular disease in the UK Clinical Practice Research Datalink database between 1995 and 2017. More than half of the men received testosterone gels or creams while a third of the men received injections.
The results show a 21 percent increased risk for the composite of heart attack and blockage-type stroke or transient ischemic attack (TIA) in current TRT users compared to nonusers after adjusting for more than 20 potential confounding factors. This corresponds to an adjusted risk difference of 2.4 events per 1000 persons per year.
The risk was highest in the first six months to two years of continuous use and mostly driven by an increased risk among men aged 45 to 59 years.
Surprisingly, current TRT use was associated with a lower risk for all-cause death rate and past use was associated with an increased risk when compared with nonuse. This may have happened because these men became less healthy and they did not consider hormone therapy a vital treatment, so they stopped it.
However, there are some plausible mechanisms by which TRT might decrease death rate. For example, testosterone increases strength, which could have meant these men did not fall and break their hips or die from fractures.
At the end of the day, the main message is that it is an individual decision to balance the risks and benefits of whether or not to use this treatment in the context of the potential cardiovascular risks and potential expected benefits.
It is likely going to be neither panacea nor will it be diabolically evil. There will be subtleties and much to learn from more research and interpretation of that research.
If you are a man who feels like you are suffering from low testosterone-induced symptoms, like weakness, fatigue and decreased sex drive and function, and you are willing to take a small risk of having a heart attack or stroke, see your healthcare provider for evaluation and treatment.