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Health Column: Low T Syndrome

Phil Mohler, M.D.
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist

Low T Syndrome …

Gotta hand it to the pharmaceutical industry. they really know how to create markets for their products. Think irritable bowel syndrome, shyness, baldness, restless legs, unhappiness and now the male menopause, the andropause.

There are millions of American men who are often tired, grumpy and for the moment not even interested in sex (just a very brief moment), all of whom are getting older. This is the huge lucrative target for the makers of testosterone products — pills, injections, patches or roll-on solutions for your armpits.



The hype is great! Build bone and muscle! Lose fat! Increase sports performance! Lift your libido!

Unfortunately, the science of testosterone replacement, particularly in older men, lags far behind the marketing hype.



HERE’S WHAT WE DO KNOW:

1) For a very small group of young men who do not produce adequate amounts of testosterone (hypogonadism), replacement therapy is life changing.

2) In normal men, testosterone levels peak in the decade between ages 20-30 years and then begin to fall at a rate of 1 percent per year.

3) Many older men with “low” testosterone levels do not have any symptoms. What is a “normal” testosterone level in a 65 year old man, anyway? We don’t know.

4) The Institute of Medicine concludes that testosterone therapy results in only small improvements in lean body mass and body fat and libido (but not on erectile function or sexual satisfaction) and has inconsistent, or no, effect on weight and depression.

5) There are conflicting results from the small, poorly designed studies that looked at the side effects of testosterone replacement in older men. However, in a large study published last month, more than 55,000 men who received testosterone were twice as likely to have a heart attack in the three months after starting testosterone than in the three months before starting the drug. Testosterone probably does not cause prostate cancer, but some data suggest that it may accelerate tumor growth.

Recall the three basic strategies of disease mongering.

First, lower the bar for diagnosis. The Low T campaign suggests that it is abnormal to have a testosterone level below 350 mg./dl. and that makes 26 percent of U.S. men candidates for therapy.

Second, raise the stakes so men want to be tested. “Low T causes low energy, lack of sex drive, irritability, brittle bones, bad mood … death.”

Third and finally, disease mongers spin the evidence about the benefits of their products, but rarely mention the side effects. The Low T campaign has simply chosen to ignore the data that we do have.

My Take: The testosterone data is limp. We need large well done, non-biased studies to answer the dangling testosterone questions. Until then, for most older males, using testosterone is engaging in a risky uncontrolled experiment.

GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at pjmohler@bresnan.net.


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