The Testosterone Controversy- politics not medicine

Posted: Apr 22 in WLCNY News by

The Testosterone ControversyIn March, the FDA revealed a new warning label for prescription topical and injectable products used for men for anti-aging purposes – or age related testosterone deficiency. Usually, when new recommendations surface, it is because new, compelling research was produced that revealed an increased risk of some adverse health outcome.  This did not happen in this case. If you read the above report, you notice the statement:

The FDA has concluded that there is a possible increased cardiovascular risk associated with testosterone use. These studies included aging men treated with testosterone. Some studies reported an increased risk of heart attack, stroke, or death associated with testosterone treatment, while others did not.

Keep in mind the exclusion was testosterone used to treat known medical issues, including hypogonadism in men related to obesity.  Still- the sudden warning with no new data should strike you as odd. In an effort to understand the FDA change of heart, the CMDh (Coordination Group for Mutual Recognition and Decentralised Procedures–Human), a regulatory body representing European Union member states met, reviewed the data and concluded:

There is no consistent evidence of an increased risk for heart problems with testosterone products.

So what’s going on here?  Why the sudden change of heart from the FDA? Why do the Europeans interpret the same data differently?

My answer is: politics. As the baby-boomers enter into retirement and are more engaged in their health than previous generations, a demand arises to improve not only the quantity but the quality of their lives.  Anti-aging medicine is incredibly popular, focusing on an improved quality of life until the inevitable occurs.  Unfortunately, as we move into a government run health care model, the pot is only so big, and anti-aging medicine comes head-to-head with policies created to run an affordable health care model.  In fact, a recent interview with Ezekial Emanuel, the architect of the Affordable Care Act, entitled “Why I want to die at 75”  promotes the exact opposite- a shorter lifespan:

Americans seem to be obsessed with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible. This has become so pervasive that it now defines a cultural type: what I call the American immortal.  I reject this aspiration. I think this manic desperation to endlessly extend life is misguided and potentially destructive. For many reasons, 75 is a pretty good age to aim to stop.

So where does that leave us? You- a patient who desires a happy, healthy life, and me- a physician who strongly believes in my Hippocratic Oath to first do no harm? Every new therapy has a risk/benefit ratio, and if the benefit is outweighed by the risk, that it is worth pursuing.  Here are my recommendations:

1. If you are an obese or overweight man with low testosterone, you should consider replacement.  Testosterone increases muscle mass which improves metabolism, in turn decreasing fat and improving your cardiac health dramatically as long as it is accompanied by a diet and exercise plan.  Plant-based testosterone therapy (such as that found in injectable Sotto-Pelli pellets used in our office) have been studied extensively and found to pose no risk to cardiac health.   They decrease total cholesterol, triglycerides, increase HDL (good cholesterol) and decrease LDL (bad cholesterol).   Testosterone also improves energy, concentration, mood, exercise tolerance, libido and sexual function.

2.  If you are a male with existing cardiac disease, you may want to talk to your cardiologist first before using topical or injectable forms of testosterone.  As mentioned above, plant based bioidentical forms improve short term and long term cardiac health, and this would be a far better choice for you.

3.  If you are a woman in your mid 30s or older with testosterone levels less than 70, you should consider plant-based testosterone replacement, particularly if you are struggling with issues such as difficulty concentrating, decreased libido, decreased exercise tolerance and fatigue.  If you are also experiencing estrogen deficiency (hot flashes, night sweats, word finding issues, troubles sleeping, irritability, vaginal dryness) you should consider bioidentical estrogen replacement as well.  Please speak to the front desk or Sam for more information.

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