New Findings, New Thoughts

Testosterone: A Study in Medical Neglect

(An unpublished op-ed.)

          Testosterone, the hormone responsible for strength, vigor, and sexuality in both sexes, is frequently in the public eye. Unfortunately, the reasons are either its illegal use and abuse by athletes, or stories about its intimate effect on our libido. This notoriety given the hormone by the media, along with unwarranted ominous official warnings and confused indications has kept the public, and most of the medical profession, ignorant of the great tragedy of the disease of testosterone deficiency. About ten years ago, after practicing primary care internal medicine for twenty-five years, I stumbled upon my still evolving discovery of the diverse adverse effects of testosterone deficiency. I was surprised to learn that the condition is very common and exists in all adult age groups. A study done at the University of Florida, published in the July 2006 issue of the International Journal of Clinical Practice revealed that almost 40% of men over forty-five are deficient in testosterone.

          Type II diabetes is just one of the common, major, diseases that has significant roots in testosterone deficiency. I’ve found that essentially all my diabetic patients were also deficient in testosterone. Replacement therapy resulted in marked improvement in their diabetic parameters, even to the disappearance of mild forms of the disease on several occasions. In recent years this causative association has become well documented in the medical literature.

          A study from the UK published in the June 2006 issue of the European Journal of Endocrinology concluded,

          “Testosterone replacement therapy reduces insulin resistance and improves glycaemic control in hypogonadal men with type 2 diabetes.”

          In other words, giving testosterone to deficient men improved their diabetes.

          A study out of Johns Hopkins in the August 2006 issue of the Journal of Clinical Oncology showed that the metabolic syndrome (obesity, type II diabetes, hypertension, high cholesterol, and, ultimately, coronary artery disease) developed in more that half the men deprived of testosterone during treatment for prostate cancer. A study out of the UK published in the International Journal of Clinical Practice, February 2007 was titled,

          “Hypoandrogen-metabolic syndrome: a potentially common and underdiagnosed condition in men.”

          These researchers, like many others, consider low testosterone (hypoandrogenism) to be common and an integral part of the metabolic syndrome.

          Another study from Johns Hopkins University published in the February 2007 issue of Diabetes Care concluded,

          “Low free and bioavailable testosterone concentrations in the normal range were associated with diabetes, independent of adiposity (obesity). These data suggest that low androgen (testosterone) levels may be a risk factor for diabetes in men.”

          With these and other reports of the causative association between testosterone deficiency and type II diabetes one would expect that a serum testosterone level would be a routine part of any evaluation of the disease. It is not. Extremely few physicians ever order the test. The great bulk of type II diabetics are being treated inadequately. The associated consequences of heart disease, blindness, kidney failure, vascular blockages, etc., are being allowed to progress. Indeed, a study out of the University of Arizona, published in the March 2007 American Journal of Physiology, Renal Physiology, showed that making female diabetic mice deficient in sex hormones not only worsened their diabetes, but hastened the onset of diabetic kidney disease.

          Why this uniform neglect of diabetes, along with all the other diseases related to testosterone deficiency? The media and some government agencies have made doctors terrified of testosterone despite the fact is that no significant downside to replacing this vital hormone in either sex has been found. During the past ten years I have encountered minimal and inconsequential side effects in women. Problems such as facial hair growth essentially disappear once the proper dose is found. I have found no adverse effects of any kind in men. The media reports of undesirable effects of testosterone involve people taking enormously high, non-physiologic, quantities.

          One excuse often used by doctors to avoid involvement with the hormone is concern about the development of prostate cancer. T his connection has been well debunked. A study out of Harvard in the November 2006 issue of European Urology concluded:

          “This historical perspective reveals that there is not now-nor has there ever been-a scientific basis for the belief that testosterone causes prostate cancer to grow. Discarding this modern myth ...”

          One month later the authors of a study done at Curie University stated:

          “... the long standing "androgen hypothesis" of increasing risk with increasing androgen levels can be rejected.”

          Ironically, through the mechanism of low grade chronic prostatitis arising from inadequate sexual activity, testosterone deficiency is likely a primary cause of prostate cancer.

          Other excuses are used to ignore this disease. Fear of some adverse effect on the heart is cited by some. A paper out of Columbia University, however, published in the American Journal of Cardiology in December 2005 stated:

          “There is no contraindication for testosterone therapy in men with cardiovascular disease and diagnosed hypogonadism with or without erectile dysfunction.”

          Incredibly, as with prostate cancer, here also the converse is true. Little predisposes to coronary artery disease more than diabetes.

          Perhaps the most widely used professional excuse to avoid dealing with testosterone deficiency is the worn warning that more long term studies need to be done. Testosterone has been available by prescription since at least 1953. How can it be that a hormone vital to health and reproduction hasn’t been studied enough in over a half-century? Even if that excuse was valid, where is the short term treatment?

          As is the case with type II diabetes, testosterone deficiency is a major causative element in cardiovascular and peripheral vascular diseases, congestive heart failure, osteoporosis, senile dementia, and chronic depressive and anxiety states. Corroborative studies abound. Absence of the hormone is a common cause of chronic fatigue. The disease may well play an underlying role in multiple gynecological problems and even breast cancer. Because of weakness in respiratory muscles it likely worsens chronic pulmonary diseases and predisposes the aged to pneumonia. The list goes on and on.

          This era of appalling gross medical neglect of a hormone deficiency state that seeds or fertilizes a whole host of other diseases must come to an end. The cost in human suffering, infirmity, and death is incalculable. The cost to society in dollars is unimaginable.

          Barry Gordon, MD

New Findings, New Thoughts