Our Perspective on Testosterone Replacement for Men

Our Perspective on Testosterone Replacement for Men

At Modern Age, we strongly believe in the importance of supporting optimal testosterone levels in order to promote overall well-being as well as prevent different chronic diseases for men. However, conventional medical standards currently dictate that testosterone therapy should not be prescribed to men unless levels reach an extremely low level (less than 200ng/ml for men in the presence of specific symptoms). We believe that a much broader group of people can benefit from testosterone therapy, based on our experience and our interpretation of the available literature. Accumulating research suggests there are benefits for men when testosterone therapy is used appropriately, despite the controversy associated with the medication.

For men, testosterone levels naturally decline with age. Lower testosterone in aging men correlates with sexual dysfunction, reduced muscle mass, depressed mood, and lower bone density (Morgentaler et al., 2016). Multiple meta-analyses associate low testosterone with higher all-cause and cardiovascular mortality (Araujo et al., 2011; Ruige et al., 2011).

Testosterone therapy demonstrates benefits in hypogonadal men. Randomized trials found testosterone improved sexual function, lean body mass, bone mineral density, insulin sensitivity, and psychological well being (Buvat et al., 2013). Testosterone also shows cardiovascular benefits, improving exercise capacity, glycemic control, and lipid profiles in men with heart failure and metabolic disease (Malkin et al., 2006; Jones & Saad, 2009). intima-media thickness also decreased with testosterone therapy, indicating reduced atherosclerosis progression (Makinen et al., 2005).Importantly, testosterone also does not appear to create disease risks. Testosterone does not appear to raise cardiovascular risks. Large studies found testosterone did not adversely affect lipid profiles, liver function, or clotting factors (Davis et al., 2008), and there was no increase in cardiovascular events compared to controls (van Staa & Sprafka, 2009).

While some studies raised concerns about cardiac risk, a meta-analysis found no increased risk of cardiovascular events with testosterone therapy (Haddad et al., 2007). The TOM trial, which was halted due to cardiovascular events, had methodological flaws and failed to show increased event rates with statistical significance (Basaria et al., 2010). The retrospective VA study claiming increased heart attacks with testosterone relied heavily on statistics to overturn very low raw event rates (Vigen et al., 2013).

In summary, a growing body of research suggests testosterone therapy provides benefits for men when appropriately prescribed for documented testosterone deficiency. Well-designed studies have not observed increased cardiovascular risks. However, more research is still needed to better characterize its effects long-term. Present data indicates testosterone is underutilized as a safe hormone therapy when correctly implemented and monitored.

References:

Araujo, A.B., Dixon, J.M., Suarez, E.A., Murad, M.H. & Guey, L.T. (2011). Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis. Journal of Clinical Endocrinology & Metabolism, 96(10), 3007-3019.

Aleman, A., Bronk, E., Kessels, R.P.C., Koppeschaar, H.P.F. & van Honk, J. (2004). A single administration of testosterone improves visuospatial ability in young women. Psychoneuroendocrinology, 29(5), 612-617.

Basaria, S., Coviello, A.D., Travison, T.G., Storer, T.W., Farwell, W.R., Jette, A.M., Eder, R., Tennstedt, S., Ulloor, J., Zhang, A. & Choong, K. (2010). Adverse events associated with testosterone administration, New England Journal of Medicine, 363(2), 109-122.

Buvat J., Maggi M., Guay A. & Torres L.O. (2013). Testosterone deficiency in men: systematic review and standard operating procedures for diagnosis and treatment. Journal of Sexual Medicine, 10(1), 245-284.

Cardoza, L., Gibb, D.M., Tuck, S.M., Thom, M.H., Studd, J.W. & Cooper, D.J. (1984). The effects of subcutaneous hormone implants in the climacteric. American Journal of Obstetrics and Gynecology, 5, 177-184.

Davison, S.L., Bell, R.J., Gavrilescu, M., Searle, K., Maruff, P., Gogos, A., Rossell, S.L., Adams, J. & Davis, S.R. (2011). Testosterone improves verbal learning and memory in postmenopausal women. Results from a pilot study. Maturitas, 70(3), 307-311.

Davis, S.R., Moreau, M., Kroll, R., Bouchard, C., Panay, N., Gass, M., Braunstein, G.D., Hirschberg, A.L., Rodenberg, C., Pack, S., Koch, H., Moufarege, A. & Studd, J. (2008). Testosterone for low libido in postmenopausal women not taking estrogen. New England Journal of Medicine, 359(19), 2005-2017.

Davis, S.R., McCloud, P., Strauss, B.J.G. & Burger, H. (1995). Testosterone enhances estradiol’s effects on postmenopausal bone density and sexuality. Maturitas, 21(3), 227-236.

Debing, E., Peeters, E., Duquet, W., Poppe, K., Velkeniers, B. & Van den Brande, P. (2007). Endogenous sex hormone levels in postmenopausal women undergoing carotid artery endarterectomy. European Journal of Endocrinology, 156(6), 687-693.

Dimitrakakis, C., Jones, R., Liu, A. & Bondy, C. (2004). Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy. Menopause, 11(5), 531-535.

Golden, S.H., Maguire, A., Ding, J., Crouse, J.R., Cauley, J.A., Zacur, H. & Szklo, M. (2002). Endogenous postmenopausal hormones and carotid atherosclerosis: a case-control study of the atherosclerosis risk in communities cohort. American Journal of Epidemiology, 155(5), 437–445.

Guay, A.T., Munarriz, R., Jacobson, J., Talakoub, L., Traish, A., Quirk, F., Goldstein, I. & Spark, R. (2004). Serum androgen levels in healthy premenopausal women with and without sexual dysfunction: Part A. Serum androgen levels in women aged 20–49 years with no complaints of sexual dysfunction. International Journal of Impotence Research, 16(2), 112-120.

Haddad, R.M., Kennedy, C.C., Caples, S.M., Tracz, M.J., Boloña, E.R., Sideras, K., Uraga, M.V., Erwin, P.J. & Montori, V.M. (2007). Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clinic Proceedings, 82(1), 29-39.

Iellamo, F., Volterrani, M., Caminiti, G., Karam, R., Massaro, R., Fini, M., Collins, P. & Rosano, G.M.C. (2010). Testosterone therapy in women with chronic heart failure: a pilot double-blind, randomized, placebo-controlled study. Journal of the American College of Cardiology, 56(16), 1310-1316.

Jones, T.H. & Saad, F. (2009). The effects of testosterone on risk factors for, and the mediators of, the atherosclerotic process. Atherosclerosis, 207(2), 318-327.

Makinen, J., Jarvisalo, M.J., Pollanen, P., Perheentupa, A., Irjala, K., Koskenvuo, M., Makinen, J., Huhtaniemi, I., Raitakari, O. & Juvonen, T. (2005). Increased carotid atherosclerosis in andropausal middle-aged men. Journal of the American College of Cardiology, 45(10), 1603-1608.

Malkin, C.J., Pugh, P.J., Morris, P.D., Kerry, K.E., Jones, R.D., Jones, T.H. & Channer, K.S. (2006). Testosterone replacement in hypogonadal men with angina improves ischaemic threshold and quality of life. Heart, 90(8), 871-876.

Morgentaler, A., Zitzmann, M., Traish, A.M., Fox, A.W., Jones, T.H., Maggi, M., Arver, S., Aversa, A., Chan, J.C., Dobs, A.S. & Hackett, G. (2016). Fundamental Concepts Regarding Testosterone Deficiency and Treatment: International Expert Consensus Resolutions. Mayo Clinic Proceedings, 91(7), 881-896.

Ramsden, M., Shin, T.M. & Pike, C.J. (2003). Androgens modulate neuronal vulnerability to kainate lesion. Neuroscience, 122(3), 573-578.

Ruige, J.B., Mahmoud, A.M., De Bacquer, D. & Kaufman, J.M. (2011). Endogenous testosterone and cardiovascular disease in healthy men: a meta-analysis. Heart, 97(11), 870-875.

Slemenda, C.W., Hui, S.L., Longcope, C. & Johnston, C.C. Jr. (1990). Predictors of bone mass in perimenopausal women. A prospective study of clinical data using photon absorptiometry. Annals of Internal Medicine, 112(2), 96-101.

Turna, B., Apaydin, E., Semerci, B., Altay, B., Cikili, N. & Nazli, O. (2005). Women with low libido: correlation of decreased androgen levels with female sexual function index. International Journal of Impotence Research, 17(2), 148-153.

Van Staa, T.P. & Sprafka, J.M. (2009). Study of adverse outcomes in women using testosterone therapy. Maturitas, 62(1), 76-80.

Vigen, R., O'Donnell, C. I., Barón, A. E., Grunwald, G. K., Maddox, T. M., Bradley, S. M., Barqawi, A., Woning, G., Wierman, M. E. & Plomondon, M. E. (2013). Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA, 310(17), 1829-1836.