Exposing the Myths About Testosterone Replacement Therapy

Today, many people, including surprisingly most practising doctors, still cling on to the old dogma that Testosterone Replacement Therapy (TRT) for older men is dangerous and leads to an increased incidence of prostate cancer. They do this despite the fact that there is not a single shred of evidence to support this folktale and there never was.
Where did this figment of the medical imagination come from then you may well ask? Search the medical literature as you may, I promise you that you will not come up with one single peer review paper that supports the notion that boosting a man’s testosterone levels increases his chances for developing prostate cancer or any other cancer for that matter. They simply are not there. They are not there because the scientific evidence for them is not there.
However, here is where many doctors may still be confused. If a man develops metastatic prostate cancer one of the first lines of therapy for him will be to knock out all his testosterone. Today this is usually achieved quite easily with medicines like Finasteride. Once this patient’s testosterone levels are reduced to near zero levels he will go into at least a temporary remission from his prostate cancer. So, if very low levels of testosterone are temporarily curative of prostate cancer then surely it follows that very high levels are causative. Is that not just common sense?
No, sorry, that is not just common sense and it most certainly is not scientific. This kind of woolly thinking – that if the absence of something is curative then a lot of the same thing must be causative, is called a corollary. Corollaries are often used in religious debate and mathematical theory. Corollaries have no place in science and definitely no place in medicine. They can lead you astray and confuse you as clearly they do in this instance.
Besides, this is also worth noting. Prostate cancer is predominately a disease of older men with declining testosterone levels. It is not at all a disease of younger men with high levels of this sex hormone circulating in their blood. How then can you argue that testosterone replacement therapy might be conducive to prostate cancer? Surely if anything the opposite would be the case although I am not attempting to make that case here.
Let us then put the final nail in the coffin of this pishogue about testosterone causing cancer. A recently conducted study into the safety of testosterone replacement therapy, carried out by M.R. Feneley and M. Carruthers at The Institute of Urology and Nephrology University College, London and you don’t get much grander than that; concluded thus:
The incidence of prostate cancer in this group of men (1,500) treated with testosterone over many years was equivalent to that expected in the general population.
While I’m at it then, let me just dispel another medical myth, popular among doctors about TRT. Doctors still cling to the fallacy that, in order to decide which men should be considered for TRT, it is necessarily to first of all take blood for hormonal level assay. This is no longer the case. A recent study conducted by Trinick, Carruthers, Wheeler et al concluded as follows:
Though laboratory assays can support the diagnosis of androgen deficiency in men, they should not be used to exclude it.
Here are just a few disadvantages in the over reliance of hormonal assay in deciding who may or may not benefit from TRT:
• Testosterone levels vary from hour to hour during the day and from laboratory to laboratory.
• Knowing the man’s age you already know that his T levels will be depressed so you learn little or nothing from blood tests.
• These tests are expensive and add significantly to the overall cost of TRT.
• Testosterone levels can not exclude the presence of testosterone deficiency syndrome.
In my practise today I have long abandoned reliance on drawing blood for T levels. Instead I now rely on my patient scores on a standard calibrated questionnaire called the ADAM test. This is my very inexpensive and accurate tool to determine if a man is suffering from a lack of testosterone or not. I also use it of course to monitor progress or lack of it as we go along.
Testosterone Deficiency Syndrome is not about grumpy old men with flagging libido and erectile dysfunction. It is a far more serious condition than just that. It carries serious potential consequences, including premature death. It needs to be taken very seriously. It has been described as universally the most under diagnosed and under treated disease in older men. And yet that ever simple and safe treatment can bring about so many benefits. These will include:
• Reduced incidence of Type 2 diabetes.
• Reduced incidence of coronary artery disease and senile dementia.
• Reduction of all risk factors associated with the Metabolic Syndrome.
• Increased muscle mass and strength.
• Decreased visceral fat.
• Increased libido and reduction of erectile dysfunction.
So how will you spot the man man who might consider a trial of testosterone replacement therapy? Here are some of the things to look out for:
• He will be over 55 years of age although he may be a lot younger.
• He will sidle up to the counter, embarrassed, clutching a script for an ED treatment.
• He may quip about wondering why he bothers anymore about sex because he has little interest in the subject.
• He will have a pot belly and be taking antihypertensive and statins.
• He may even be on antidepressant.
• He may already have Type 2 diabetes.
Should you spot such a man coming into your Community Pharmacy you are actually in a very strong position to give him some really sound advise. Don’t just assume that if he is suffering from testosterone deficiency syndrome then surely his own doctor will have spotted this and recommended treatment. This is still not happening today. No, have a quiet word in his ear and at least plant the notion of TRT in his head. You might literally be saving his life.