Is testosterone replacement therapy right for you?

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Is testosterone therapy safe?

Q&A with Dr. Manny: I recently heard that taking testosterone supplements could cause a heart attack or stroke. Should I be worried?

Recently, much has been written about testosterone and male hormone replacement therapies.  Symptoms of low testosterone may include fatigue, loss of muscle mass and increased abdominal fat.  Other symptoms may include depressed mood, decreased libido and sexual dysfunction.  Testosterone replacement therapies have become increasingly popular and many physicians are beginning to offer “age management” therapies to a wider range of patients.

Testosterone is a hormone essential to the development of male growth and masculine characteristics. Currently, testosterone products are FDA-approved only for use in men who lack or have low testosterone levels.  Testosterone replacement can be offered in many forms including injections, gels, skin patches and mouth patches.  While there are oral testosterone pills available, many experts believe that the oral administration of testosterone may have negative effects on the liver and recommend these other routes of delivery.

In the last year, there have been some studies have found that men taking testosterone have more cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. Some physicians also have a lingering concern that testosterone therapy could stimulate the growth of prostate cancer cells. However, when we examine all of the available clinical trial data, we find that, overall, the evidence is mixed, with some studies showing a lower cardiac risk with testosterone therapy and no apparent effect on prostate cancer.

While testosterone therapy is thought to be generally safe, we do not yet know the long-term effects of taking the hormone.  Testosterone does have several side effects that have been observed in some patients who are receiving hormone replacement therapy. These may include itching or irritation at the site at which it is applied as well as an increase in the size of the prostate – this may result in a condition known as Benign Prostatic Hypertrophy (BPH) and result in difficulty with urination.  We also know that   Testosterone increases the production of red blood cells, which can clump together or coagulate, essentially making blood thicker – this may be what predisposes certain at-risk people to higher rates of stroke and heart attack observed in some of the scientific studies published in the last year.

At present, the FDA has not concluded that FDA-approved testosterone treatment increases the risk of stroke, heart attack, or death but there are ongoing investigations underway.  Patients who are already should not stop necessarily stop taking prescribed testosterone products—rather make sure that you have had meaningful discussions with your physicians about the risk and benefits of therapy in your particular case.. As with any treatment or therapy, health care professionals must carefully whether the benefits of FDA-approved testosterone treatment is likely to exceed any potential risks of treatment.

According to the Global Market Report, testosterone replacement therapy will likely be a 5.1 Billion dollar industry by 2018 and the largest market worldwide is the United States. The ongoing marketing blitz promises that treating "low T" this way can make men feel more alert, energetic, mentally sharp, and sexually functional.  However, Until more research is done to conclusively answer the lingering questions about testosterone therapy, We must carefully consider if hormone replacement therapy is right for you.

Tips when considering testosterone replacement therapy:

•      Be sure to evaluate all possible reasons for symptoms attributable to low testosterone, like fatigue, low sex drive, and others. These symptoms are often vague and may be caused by a plethora of other problems including a lack of a balanced, nutritious diet, regular exercise, good quality sleep, depression, or ongoing relationship issues.

•      It is essential to work closely with a reputable healthcare provider and ensure that before considering therapy that you get an accurate measure of testosterone. This hormone should be measured between 7 am and 10 am, when it's at its peak. Confirm a low reading with a second test on a different day.

•       If you do opt for testosterone replacement therapy it is vital that your physician obtain regular lab work to assess response to therapy as well as screen for any potential developing side effects.

Men at high risk such as those with a history of prostate cancer or those at high risk for prostate cancer should approach testosterone therapy with extra caution.  Patients with heart disease, multiple risk factors for heart disease, or those with prior heart attack or stroke should be carefully screened for progression of disease both before and during therapy

Ultimately, testosterone replacement therapy is like any other medical treatment.  As healthcare consumers, we must work closely with our physician and determine if the drug is right for you.  It is essential to ask questions and determine if the benefits of the testosterone therapy outweigh the risks and then carefully monitor for side effects throughout the treatment period.