Testosterone Replacement Therapy. A Freash Look Perhaps.

Testosterone Replacement Therapy. A Fresh Look Perhaps?

Andrew Rynne.
June 2011.

It has to be admitted, the word itself, “testosterone” does not usually evoke positive feelings or responses. In the popular press, the term testosterone is too often associated with reports about boy racers, reckless driving, male aggression, dodgy bodybuilding techniques, commercial dominance, sexual misbehaviour and cheating in competitive sports. All pretty negative stuff.

In the medical press the word “testosterone” does not fare much better in certain quarters. Mention of testosterone replacement therapy (TRT) to your average doctor is likely to elicit vague objections to do with increased cancer risks, it being not natural, it being unnecessary and other generally negative and ill-defined resistance to the suggestion. This may be a pity.

No, let’s face it; testosterone replacement therapy was never going to be an easy sell. But are things changing? I for one very much hope that they are. I have been at this for almost ten years now, quietly promoting the notion of TRT. To summarily dismiss TRT as unnecessary, unnatural or even dangerous, might be to deny some older men a chance for a better quality of life and a chance for a reduced risk of contracting some of the less savoury side effects associated with the ageing process including premature death.

Recently three studies have yet again raised the profile of TRT from that of mere libido booster to that of life saver and life extender.

(1) Low serum testosterone and increased mortality in men with coronary artery disease.

In a large study conducted by Chris Markin et al, through the Department of Cardiology, Royal Hallamshire Hospital in Sheffield on 930 consecutive men with proven coronary artery disease recruited between June 2000 and June 2002 and followed up for a mean of 6.9 years the Authors concluded:

In patients with coronary disease Testosterone deficiency is common and impacts significantly negatively on survival. Prospective trials of Testosterone replacement are needed to assess the effect of treatment on survival.

(2) Effects of Testosterone Undecanoate (Nebido) on Cardiovascular Risk Factors and Arteriosclerosis in middle aged men with late onset Hypogonadism and Metabolic Syndrome.

This was a randomised double-blind placebo-controlled study on 50 men with mean age of 57 + or – 8 years who received 1,000 mg of Testosterone Undecanoate every 12 weeks or placebo.

Conclusion. Testosterone Undecanoate reduced fasting glucose, waist circumference, and improved surrogate markers of atherosclerosis in hypogonadal men with Metabolic Syndrome. Resumption and maintenance of T levels in the normal range of young adults determines a remarkable reduction in cardiovascular risk factors clustered in Metabolic Syndrome without significant haematological and prostate adverse events.

(3) Effects of Testosterone Replacement Therapy on Depressive Symptoms and Sexual Dysfunction in Hypogonadal men with Metabolic Syndrome.

This was a multi-centred, placebo controlled, study directed from the Department of Psychiatry, Leiden University Medical Centre in the Netherlands. In it 184 men suffering from Metabolic Syndrome and Hypogonadism were treated for thirty weeks with either Testosterone Undecanoate or placebo.

Conclusions. Testosterone Undecanoate administration may improve depressive symptoms, aging male symptoms and sexual dysfunction
in hypogonadal men with the Metabolic Syndrome. The beneficial effects of testosterone were most evident in men with the lowest baseline total testosterone levels.

With all this good news about TRT crashing in on us it is remarkable to think that there are still thousands of doctors out there resistant, if not indeed frankly hostile, to the notion that TRT might be actually good for a man. In a follow up article I will attempt to analyse what it is that makes these medics tick.