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Sports television, magazines and the Internet are filled with ads for “low T” therapy, or low testosterone therapy. Between images of muscle cars, improved golf swings and increased libido, it’s hard to know if these treatments are beneficial or just advertising smoke and mirrors.

Current estimates show nearly 6 million men are on testosterone hormone therapy. Sales of low T therapy have more than doubled since 2006, and $1.6 billion is spent annually. Low T treatment is aimed at men over 50 who experience fatigue, moodiness, weight gain or a decreased sex drive. But could it lead to long-term and potentially fatal consequences?

THE FACT

While testosterone naturally decreases as men age, for some the drop becomes a medical problem. Testosterone contributes to bone density, fat composition, mood, muscle tone and sexual health. Research shows the incidence of low testosterone increases with age and may be linked to other health conditions (see charts at right).

“If you have questions and concerns, see your physician, particularly if you have a sudden onset of symptoms,” says Zamip Patel, MD, urologist with Florida Hospital East Orlando.

Am I a Candidate for Low T Therapy?
Dr. Patel cautions it’s important not to self-diagnose because symptoms may be a sign of other conditions. He advises early preventative care. Men in their 40s to late 50s should receive a complete checkup including, but not limited to, the prostate and heart and a blood test to measure the testosterone level, if necessary.

“Carefully selecting the right patients for testosterone therapy is key,” says Dr. Patel. Age, heart health and prostate health are important considerations for any man considering low T treatment.

THE POSSIBLE DANGERS OF TESTOSTERONE THERAPY

A recent study found that men older than 65 with a history of heart disease were twice as likely to have a heart attack soon after beginning testosterone therapy.

The same study confirmed previous research that found men of this age without a history of heart disease also are twice as likely to have a heart attack after beginning hormone therapy. Men under age 65 without a history of heart problems weren’t found to be at increased risk. A previous study theorized the rise in heart attacks might be a result of an increase in blood clots due to testosterone therapy. However, Dr. Patel points out that there is significant controversy among the medical community regarding the methods used to arrive at these studies’ conclusions.

Rajesh Shah, MD, cardiologist and medical director of the Acute Coronary Syndrome Program at Florida Hospital Orlando, cites a January Food and Drug Administration (FDA) alert expressing concern about testosterone therapy and cardiac health.

“While the results aren’t surprising, there are consequences with any therapy,” he says. “In this case, there may be cause to reassess the benefit [of testosterone therapy] versus the cardiac risk.”

Besides heart concerns, another serious consideration is the possibility of accelerating existing aggressive prostate cancer cells. “It’s like adding fuel to a fire,” cautions Dr. Patel.

For men who have aggressive prostate cancer, low T replacement therapy isn’t routinely recommended.

For those on the therapy, regular prostate screenings are advised.

DON’T FORGET THE BASICS

In addition to seeing your physician, Dr. Patel reminds those considering low T therapy not to discount the importance of healthy diet and exercise in how they feel. “The simple things can be the most important,” he says.

Dr. Shah agrees. “It is hard work, but more rest, eating properly, and losing the weight may be what’s needed.”

Testosterone therapy may be indeed indicated for some men, but the therapy needs more long-term safety trials to clarify benefits and risks.

MD

Rajesh Shah, MD

MD

Zamip Patel, MD

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