Problems with Testosterone Treatment in Older Men

Early in 2008 several clinical studies were published in support of the use of testosterone in older men, almost as a panacea for aging changes.  Two of them even implied that such therapy was safe and without obvious drawbacks.  Now the New England Journal of Medicine has published two studies and the Journal of Clinical Endocrinology and Metabolism another that provoke questions about the widespread use of testosterone in treating waning plasma levels of the hormone with increasing age.

The first study involved 1,445 US men with an average age of 61.  The researchers wanted to examine the relationship between sex hormone levels, limitations of mobility, and physical performance.  Total testosterone blood levels were not linked to mobility limitation, subjective health, or reduced physical performance measures, whereas free blood testosterone was associated with some deterioration in reported health and some decrease in physical performance.  For those men with low free testosterone levels at baseline there was a decline in mobility (but not in reported health) during the 6½ year follow-up.

The second study tried to identify symptom-clusters associated with low testosterone levels in 3,000-odd European men aged 40-79.  The subjects were given questionnaires and had their morning levels of total and free testosterone measured.  Of 32 sexual, physical, and psychological symptoms considered as potentially related to low testosterone levels, a cluster of three - poor morning erection, low sexual desire, and erectile dysfunction - were most closely linked to low testosterone levels (total testosterone below 11 nmol/L, free testosterone below 220 pmol/L).

The third study investigated the effects of testosterone supplementation in older men.  Men with limited mobility and low total or free testosterone levels were given placebo gel or testosterone gel, to be applied daily for 6 months.  The average age of the subjects was 74, and most of them had high blood pressure, diabetes, high lipid levels or obesity.  Enrollment was halted early because significantly more adverse cardiovascular events occurred in the testosterone group than in the placebo group (23 vs. 5 events).  Those taking the testosterone gel had significantly greater improvements in leg-press and chest-press strength and in stair climbing with a load. 

Taken together, the findings from these studies suggest that sexual symptoms, rather than vague physical and psychological symptoms, should be used to diagnose older patients with hypogonadism.  However, treatment with testosterone supplements should be used cautiously, in view of the increased risk of adverse cardiovascular events.  For this reason alone, men should avoid self-diagnosis and self-treatment with spurious medications obtained without prescription, e.g. over the Internet.

Comments

[G,V.]

Thanks for an idea, you sparked a thought from an angle I hadn’t given thought to yet. Now let's see if I can do something with it.

Regards,
(edited R.G.)