Against Testosterone Treatments for Older People
This cutting opinion piece is written in opposition to the prevalence of testosterone therapy, offered in many cases with the (dubious) promise of it being a way to push back the advance of aging. Hormone therapies in general are not to be taken lightly, but are widely used. Anyone should be free to try whatever they feel may work for them, but this approach may not be justified for most people given the balance of risk and benefit. That isn't a justification for restriction of personal freedom, but rather for greater efforts to educate in the face of overly enthusiastic marketing.
It is not easy in the present environment for endocrinologists to avoid being drawn, however reluctantly, into testosterone misuse. Many endocrinologists are referred patients with a single, marginally low blood testosterone measurement seeking testosterone treatment for "hypogonadism". Under the misguidance of numerous extant guidelines or other manifestos, encourage excessive testosterone prescribing where there is any clinical doubt, which is almost always. They may fear that if they do not succumb to prescribing on demand, the patient will go doctor shopping and get the testosterone they think they need or demand elsewhere. These dilemmas are enlivened, if not enlightened, by concerted marketing and papers emanating from pharma, upscale single-issue men's health clinics, and academic enthusiasts. These rarely highlight the vested commercial interests, where present, promoting testosterone use outside approved indications under the disease-mongering rubric of "hypogonadism".
Testosterone is unique among hormones for its high level of public recognition, which unfortunately is imbued with fantasies and fictions unrelated to endocrine reality, an enchantment that easily unlocks latent but irrational wishes for rejuvenation. Reproductive medicine is unique in that, unlike other medical specialties, virtually everyone's personal experience of sex and reproduction provides them with the subjective confidence they possess sound insight into reproductive biology and medicine without needing recourse to the established objective facts. This particularly extends to beliefs about what testosterone is and does biologically. This illusion of sophisticated expertise forms a powerful coupling with tenacious wishful thinking. This latent demand is readily entrained by clever marketing from pharma and other commercial enterprises that promotes testosterone's use as an anti-ageing or sexual dysfunction tonic.
Testosterone prescribing for men without pathological hypogonadism is a therapeutic illusion in search of a definition. It is fostered by wishful thinking of an affluent populace with eyes mistily focused on the mirage of rejuvenation. The public health consequences of the recent epidemic-like increase in testosterone prescribing on cardiovascular and prostate health and iatrogenic androgen dependence remain to be evaluated over coming decades. At best it may have little adverse impact but there could be detrimental changes in cardiovascular and/or prostate health. Some evidence suggests that significant numbers of men who start testosterone treatment may have difficulty stopping it even if it proves ineffective as they become androgen dependent from androgen deficiency withdrawal symptoms while their endogenous testosterone production resumes, albeit slowly.
60yo male; I take good care of myself, but my testosterone was low though not clinical. I was having a lot of difficult functioning, and sex was becoming a distant memory .
With TRT, things are back to normal. It has cleared up a lot of anxiety which occurs for no reason, I have more energy and the will to keep going.
So they can have their opinions, but for me it was life changing.
One of the problems with the medical establishment is the assumption that human beings are like products coming off of a manufacturing line, made to six sigma standard. The reality is that each of our biochemistries are a little bit different from each other. This is why Brett above benefits from TRT whereas I would not even consider it. It also is the reason why people like myself are highly sensitive to Mercury, mostly from medical sources, whereas many others are not.
Well Said, Abelard.
@Brett TRT may make you feel better, but there is a good chance it is not good for you in the long run. Like running a car on nitrous oxide. Imo caution is warranted with this treatment.
Gheme, why do you think restoring normal levels of testosterone is bad? This seems counter-intuitive. It does not "supercharge" the system (dosed correctly), but merely restores some things so you can keep functioning.
My 2 cents. BPH is easily treatable in 2022, to even include it in an argument against TRT is an acknowledgement that your argument is weak.
The problem with any analysis of TRT patients is that most TRT patients do not take advantage of the increased physical activity that TRT allows for. IMO it is the increased physical activity, and the body's response to that activity, that is by far the greatest benefit of TRT.
JohnD, agreed.
I'm also willing to be there are a lot of people on SSRI's that really need to be on testosterone; levels have been declining, and also the overall biological burden of so many different pollutants, many of which are know as "Estrogen Like Substances" that bind to estrogen receptors, are likely affecting people.
Just my laymans view.
My testosterone levels were in range for my age bracket, said my doctor.
If I were 20 years younger I would have been diagnosed with 'pathological hypogonadism' but since everyone else around my age has comparable levels, it's considered 'normal'.
I supplemented 3mg testosterone in DMSO transdermally per day and raised my levels from measly 280ng/dl to around 700ng/dl, and boy what a difference!
The mental effect is by far the most important. I have drive again! No longer feeling weak, lethargic and depressed, way better body and mind resilience. Stopped procrastinating everything. GAME CHANGER!
I started taking testosterone the very year when the first testosterone product came on the market, in 2003. I have been using it for 19 years and I would like to warn of a danger that no one is aware of.
1) If you decide to take testosterone, you will become addicted to it until death. It can happen over the years that you come across a doctor who decides that you do not need testosterone, leaves you without it and causes you damage to your body, including diabetes, obesity, prostate enlargement and dementia.
2) after 13 years of testosterone administration, the body begins to defend itself against it and increases the activity of the aromatase enzyme. It converts testosterone to estradiol. Estradiol is a poison for men because it inhibits the production of gonadotropins, followed by fatigue, wasting and weight gain.
I recommend taking testosterone as a last resort, similar to giving insulin for diabetes II. It should be started with Enclomifene or aromatase inhibitors and 5 alpha reductase inhibitors. Add testosterone until the treatment stops working.