Feeling a little tired or moody? Carrying a bit of a spare tire? Sex life not what it once was? If you’re a man who has been paying any attention at all, you probably wonder if “low T” is causing these symptoms.
That’s because the low testosterone marketing machine works hard to get you to wonder exactly that. Men naturally experience a one percent drop in testosterone every year after age 30. That’s reason enough for pharmaceutical marketers to jump in. Testosterone sales have jumped in response - from $324 million in 2002 to over $2 billion in 2012.
But it’s not just the pharmaceutical industry that benefits from this particularly modern disease. The number of clinics that specialize in the treatment of low T skyrocketed in the last five to ten years.
There is one simple question to ask about this multi-billion dollar industry.
What’s wrong with that?
It’s the free market at its finest, right? A void exists where a treatment is needed. Industry steps in and fills the gap. Everyone is happy.
Except researchers stopped a study of testosterone in 2010 because of the number of cardiovascular events in men over 65. Multiple small trials since that time showed similar results. These studies lack the numbers to draw definite conclusions, but they throw up some red flags.
PLOS One published a cohort trial of over 55,000 patients in 2014. The risk for heart attack doubled in men over 65 on testosterone supplementation. It’s true a cohort study can’t control for all possible confounding variables. But it does raise questions about the safety of treating age-related testosterone decline.
A condition known as classical hypogonadism, not age, was the original target for testosterone therapy. In this disorder, the testes cannot produce enough testosterone, or they aren’t getting the signal from the pituitary that they should. Inflammation (remember the mumps?), tumors and injury can be responsible. Symptoms include muscle-wasting and thinning of bone.
The FDA never intended for testosterone to be used for the normal, age-related drop in testosterone levels. In fact, the FDA changed the labeling for testosterone earlier this year. It is now indicated for low testosterone due only to certain medical conditions such as classical hypogonadism. More to the point, “The benefit and safety of these medications have not been established for the treatment of low testosterone levels due to aging, even if a man’s symptoms seem related to low testosterone.”
Off-label use of medications is common in medical practice. This means the prescription of testosterone continues in large numbers, while researchers work to determine the true risks of its use.
One recent study in the Journal of the American Medical Association lowers the heart disease concern a little. This double-blind, placebo-controlled study randomized 300 men to testosterone gel or placebo. They examined testosterone’s effect on asymptomatic arterial disease. The good news is that it did not get worse, but a larger trial is needed to confirm these results. However, the rest of the study gets ugly for the testosterone cheering section.
The researchers report “Sexual desire, erectile function, overall sexual function scores, partner intimacy, and health-related quality of life did not differ significantly between groups.” Could it be that we are spending billions of dollars and investing in endless research on a treatment that doesn’t even work? For a disease that isn’t even really a disease?
At the risk of repeating myself, if you suffer from the symptoms of low T, try improving your diet, your exercise habits and your state of mind. If that doesn’t work, try asking your doctor for a placebo. It seems to work just as well as testosterone.