by Dr. E. Barry Gordon, M.D.
UNFORTUNATELY, THE “Ask the Doctor” column of Nov. 23 about the risks and benefits of testosterone therapy was as inaccurate and misleading as most media reports concerning testosterone. Here I can only address a few of the fallacies.
The author made major reference to the recently publicized Veterans Administration study purporting to show that veterans taking testosterone were 30 percent more likely to suffer adverse effects. That’s what the media was told. Few doctors bother to actually read studies. They rely on abstracts, conclusions or even just newspaper accounts. But those who read this one, and looked at the un-altered numbers, know that the veterans taking testosterone had much less than half the heart attacks and strokes and almost half the deaths of those veterans not taking testosterone. The quality of the study can be best appreciated by the fact that after filling one prescription for a month’s supply of testosterone, each veteran was then “assumed” to have continued the treatment for over a year, despite the reported fact that 17.6 percent of the veterans only filled one prescription, and all the treated veterans averaged less than an eight-month supply of testosterone.
There are a number of studies regarding the use of blood tests to diagnose testosterone deficiency. A 2006 study on testosterone blood tests from Harvard stated the following: “All reference values were based on a standard statistical model without regard for clinical aspects of hypogonadism. Twenty-three of the 25 lab directors responded that clinically relevant testosterone reference ranges would be preferable to current standards.
“Conclusions: Laboratory reference values for testosterone vary widely, and are established without clinical considerations.”
In other words, testosterone blood tests are all but worthless in the diagnosis of testosterone deficiency. In 2010, the Endocrine Society, the largest hormone organization in the country, published a more serious statement: “Testosterone assays are widely used. However, deficiencies in these assays limit their broad and effective implementation and threaten the health of those patients whose medical care relies upon its accurate measurement.”
I find more value in testosterone tests than these two studies do, but during my 15 years of treating testosterone deficiency, I have yet to encounter a doctor who understood just how grossly misleading these blood tests can actually be.
The discussion in the “Ask the Doctor” column doesn’t even scratch the surface of the role testosterone plays in our health. Hundreds of studies have shown that its loss plays a major role in promoting coronary artery disease (80 percent of all the veterans in the study had coronary artery disease), diabetes, cancer, senility, heart failure, osteoporosis, depression, anxiety and even premature death, among many other conditions.
In contrast to what this article asserts, essentially all men and women develop testosterone deficiency, and essentially all men and women eventually have symptoms of this hormone deficiency. These symptoms can sometimes appear as early as the late teenage years.
If you are more tired than you used to be, weaker, fatter, more depressed or anxious, and less interested in sex or having sexual symptoms, in the absence of other debilitating illnesses, you almost certainly have testosterone deficiency. And no, these problems are not the result of just growing older. In addition, the latest study on the subject has shown that 96 percent of patients with type II diabetes have testosterone deficiency.
The risks published in this article are greatly exaggerated. Too many red blood cells is an occasional and minimal problem – eliminated by donating a pint of blood two or three times a year. During 43 years of practicing medicine and hematology, I have never seen a case of too many red blood cells causing a heart attack. Acne is also uncommon and controlled by dosage. Dozens of published medical studies have shown that, other than in trace amounts, testosterone has absolutely no negative effects on the prostate. As a matter of fact, the lack of testosterone has been well documented to be the cause of prostate enlargement and prostate cancer.
It is a tragedy of major proportions that so many doctors continue to perpetuate the myths and old wives tales about testosterone – a basic essential hormone, vital for good health, a hormone that has been available by prescription for 60 years, a hormone that has been looked at in over 80,000 published medical studies.[divider] Dr. Gordon maintains an internal medicine/primary care practice in Flatlands.