In a new study, Boston University’s School of Medicine reports that long-term testosterone replacement therapy reduces mortality in men by up to 92 percent.
Published on February 9, 2017 in the Journal of Cardiovascular Pharmacology and Therapeutics, this study followed 656 men with low testosterone and an average age of 61. About half the men were placed on long-term testosterone replacement therapy, while the other half chose not to take testosterone replacement because of the myths that surround it as being potentially risky — despite evidence to the contrary.
Researchers followed the men for up to eight years, which in healthcare is a long-term study.
Before we talk about the final endpoints of the study, here are some things that occurred in the men with low testosterone who took replacement therapy vs. the men who chose not to take testosterone replacement because of misconceptions about safety.
Blood sugar and diabetes
The men with testosterone replacement saw favorable improvements to their blood sugar, while the men in the control group (who took no testosterone) saw no improvement of blood sugar. More profound were the changes in hemoglobin A1c, a marker of diabetes. The men who took testosterone replacement had a substantial improvement in hemoglobin A1c, meaning that they were much less likely to develop diabetes. However, the men not treated with testosterone replacement saw their hemoglobin A1c worsen over the next several years.
Both systolic and diastolic blood pressure improved over the observation. The men who took testosterone replacement went from elevated blood pressure to a normal blood pressure. In the men who opted out of testosterone replacement, their blood pressure worsened over the follow-up time.
Researchers also measured the cardiac lipids, a risk factor for heart disease. The men who took testosterone replacement had significant improvements in their cardiac lipids while the men who took no testosterone had typical worsening of their cardiac lipids over time.
The men who took testosterone replacement therapy also saw improvements in the health of their liver, which removes toxics from the body. The men who took no testosterone saw worsening of liver function over time.
Weight and obesity
The men who took testosterone replacement had a significant and sustained weight loss every single year during the eight-year follow-up. Their weight improved when they took testosterone replacement, with an average weight loss of about 40 pounds. In contrast, the men who did not take testosterone replacement steadily got heavier over the follow-up years.
The men with testosterone replacement saw a progressive improvement of their waist circumference while, of course, the men who took no testosterone steadily got thicker.
How about long-term safety beyond the improvements of risk factors? There have been numerous studies showing these same properties of testosterone replacement in men with low testosterone. Their blood pressure gets better, weight gets better, waist circumference gets better, cardiac lipids get better and blood sugar gets better.
How about more serious health concerns?
In the follow-up group, the men with testosterone replacement had one half the rate of prostate cancer compared to the men who took no testosterone replacement. There have been numerous studies showing that testosterone replacement does not increase the risk of prostate cancer and may, in fact, be protective.
Heart attack and stroke
In the men who were treated with testosterone replacement, there were no cardiovascular events such as heart attack or stroke. There were no deaths from cardiovascular disease. There were two deaths in the group of older men in the eight years, but they were unrelated to cardiovascular disease.
In the men who did not take testosterone, there were 21 deaths, 19 of them related to cardiovascular events such as heart attack and stroke. There were an additional 30 non-fatal strokes and 26 non-fatal heart attacks. Again, this compares to none in the group of men who took testosterone replacement.
(Source: “Long-Term Testosterone Therapy Improves Cardiometabolic Function and Reduces Risk of Cardiovascular Disease in Men with Hypogonadism: A Real-Life Observational Registry Study Setting Comparing Treated and Untreated (Control) Groups,” Journal of Cardiovascular Pharmacology and Therapeutics, February 2017. Authors: Abdulmaged M. Traish, Ph.D., MBA; Ahmad Haider, M.D.; Karim Sultan Haider, M.D.(C); Gheorghe Doros, Ph.D., Farid Saad, DVM, Ph.D.)Abdulmaged M. Traish
Testosterone replacement does not guarantee against a heart attack or stroke even though none of the men in this study who took testosterone had a heart attack or stroke vs. the high incidence of men who did not take testosterone. Testosterone replacement does not guarantee against prostate cancer, although we can see that men are less likely to get prostate cancer, have a heart attack or stroke, or die when testosterone is taken — even though there is a misconception that perhaps testosterone is risky. It is not.
The FDA’s misguided rules
Currently, the FDA maintains a position that drug manufacturers must label testosterone replacement as potentially increasing the risk of heart attack or stroke — even though they’ve acknowledged that there is absolutely no evidence to support this. This has had a negative impact on the health of Americans.
Some physicians are up on the current literature and use evidence-based medicine when counseling their patients. Yet most physicians will follow FDA rules, which are intended to influence manufacturers of drugs. The FDA does not have any jurisdiction over the practice of medicine.
When the FDA ruled that testosterone could increase the risk of heart attack or stroke, even though it was based on incorrect information that was later retracted, it made headlines in all the news. Now the FDA hasn’t stepped back from this, even though it is totally incorrect.
Testosterone is not only safe for men with low testosterone, it reduces heart attack, stroke and premature mortality. Numerous studies have borne this out.
A study done last year followed more than 83,000 men for about six years. They averaged about 66 years old. In that study, which I’ve talked about in a previous blog, there was over a 50 percent reduction in cardiovascular events and all causes of mortality. In the Boston University study we’re talking about here, men were followed longer and the protection from testosterone replacement therapy gets even more profound.
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If you have low testosterone, you should discuss with your doctor taking testosterone replacement. If your doctor looks at the drug labeling, he or she will see that the product is labeled as potentially causing increased risk heart attack or stroke, but that is factually incorrect — if not the exact opposite.
Dr. Charles Mok