‘Real Data on Something That We’ve Been Prescribing for Decades’

These results are the first to be reported from the study, called TRAVERSE. Later this year, other findings on so-called ‘efficacy’ outcomes, including sexual function, depressive disorder, fractures, anemia, and diabetes, are expected to be presented at a conference, and/or published in a medical journal. 

...“It doesn’t give carte blanche to prescribe to men with normal testosterone concentrations. It doesn’t tell us about the safety of that,”

LINK: WebMD

WebMD Health News

Testosterone ‘Safe’ for Most Older Men with Low Testosterone

Written by Miriam E. Tucker

June 16, 2023 -- Testosterone replacement therapy does not appear to raise the risk for heart attacks, strokes, or deaths from either, among middle-aged and older men with low testosterone and high risk for heart disease, the long-awaited results from a major clinical trial find. 

Among over ,5000 men aged 45 to 80 years, no increased risk was seen for from cardiovascular causes, nonfatal heart attack or stroke. 

SLIDESHOW

1 of 18

What Is Testosterone?

Testosterone may be the most notorious of hormones. It conjures up thoughts of muscles and masculinity. In fact, testosterone does fuel sex drive and muscle mass, but it also regulates mood and bone strength. When a man's level falls below normal, a doctor may prescribe shots, gels, or patches.  But there is some debate over who needs treatment.

2 of 18

Aging and Testosterone Levels

A slow drop in testosterone is a normal part of aging, sometimes called "andropause" or "male menopause." For many men, this doesn't cause any significant problems or symptoms. Others may notice a decline in muscle mass, depression, or less interest in sex.

3 of 18

Low Testosterone and the Body

Low testosterone can cause visible changes in some men:

• Smaller, softer testicles
• Larger breasts
• Thinner muscles (happens slowly over a period of years)
• Loss of body hair (also happens slowly, usually over a period of years)

 

4 of 18

Low Testosterone Affects Bones

You may think osteoporosis, or brittle bone disease, is a woman's disease, but it can affect men as well. Low testosterone is a common cause. As testosterone levels fall, the bones may get thinner, weaker, and more likely to break.

5 of 18

Low Testosterone and Sex

A drop in testosterone doesn't always interfere with sex, but it can make it more difficult for your brain and body to get aroused. Some men may notice a drop in libido, while others may lose interest in sex completely. Low testosterone can also make it tougher to get or keep an erection.

6 of 18

Testosterone, Mood, and Thinking

Some men have subtle problems like mood changes, poor concentration, and less energy. These symptoms can easily be caused by other health problems though, like anemia, depression, sleep troubles, or a chronic illness.

7 of 18

Low Testosterone and Infertility

Testosterone helps a man's body make sperm. When levels of the hormone are low, their sperm "count" can be low, too. Without enough sperm, they may not be able to father a child.

8 of 18

What Causes Low Testosterone?

Getting older is the most common reason testosterone levels dip. Illnesses are sometimes to blame, including:

• Type 2 diabetes
• Liver 
• obesity
• Pituitary gland problems
• Testicle injuries
• Tumors

Radiation therapy, chemotherapy, and steroid medicines can also affect testosterone levels.

9 of 18

Should You Be Tested?

Your doctor may suggest a testosterone test if you have:

• Erectile dysfunction
• Lower sex drive
• Low sperm count
• A loss of height, body hair, or muscle size

If you have an illness known to lower testosterone, your doctor may want to test your levels of the hormone.

10 of 18

Testing for Low Testosterone

Testosterone is usually measured with a blood test done early in the morning, when levels are highest. Normal levels range from 300 to 1,000 ng/DL. Your doctor may want to run this test a second time before diagnosing low testosterone.

11 of 18

Treating Low Testosterone

If you have low blood levels of testosterone AND symptoms that affect your daily life, your doctor may suggest taking supplemental testosterone.  Not everyone with low testosterone will need treatment. You may want to see a specialist to discuss the risks and possible benefits of treatment. Look for a urologist or an endocrinologist, a doctor who treats hormone problems.

12 of 18

Testosterone Replacement Therapy

If you need treatment, your doctor may prescribe testosterone to boost your levels. Some studies suggest this can strengthen men's muscles, protect their bones, and improve their sex drive, improve erectile dysfunction, and contribute to improved mood. But the effects can be quite different from one man to the next.

13 of 18

Testosterone Injections

Testosterone comes in several forms, including shots, gels, patches, and tablets you place on your gums. Injections are the least expensive option, but they can be painful. You take the shots every 2 to 4 weeks, as prescribed by your doctor. You may also be able to get the medicine without injections by using a nasal pump. Your  testosterone levels can swing up and down between doses.

14 of 18

Testosterone Gels or Patches

These are placed directly on your skin. The hormone seeps through the skin, and is slowly released into the blood. Because gels and patches are applied every day, they keep a steady level of testosterone. However, they can cause itching, irritation, and blisters at the spot where they're applied. Women and children should not touch skin treated with a gel or patch.

15 of 18

Testosterone Tablets and Pellets

Tablets are placed on the gums above your incisors every 12 hours. As the gel-like tablet dissolves it slowly releases testosterone. Gum tablets can cause a bitter taste, irritated mouth, tender gums, or headaches. These side effects may get better with time. You can eat, drink, and kiss women and children while using testosterone tablets. Testosterone pellets are placed under the skin with low continual release of T for 3-6 months which eliminates the need for a weekly or daily testosterone application. 

16 of 18

Risks of Testosterone Therapy

Testosterone therapy has some drawbacks. Some men may develop:

• Too many red blood cells
• Sleep apnea
• An enlarged prostate
• Acne

The risks and benefits of taking testosterone for many years are not known, because large studies haven't been completed, yet. Some researchers suggest there might be a higher risk of heart disease. But the evidence is still not conclusive.

17 of 18

Testosterone Use and Cancer

There's some concern that long-term use of testosterone may cause prostate cancer in older men. Men taking testosterone will need regular checkups to look for early signs of prostate cancer. This covers: All men over 50, men over 40 with a family history of prostate cancer, and all African American men.

18 of 18

Who Should Not Take Testosterone?

Men with these conditions shouldn't take testosterone:

• Prostate or breast cancer
• Poorly controlled heart disease
• Untreated sleep apnea
• Too many red blood cells
• Clotting disorders

 

Reviewed by Carol DerSarkissian on 11/28/2022

There was also no increased risk for prostate cancer over the 33-month follow-up period. However, there were increases in one kind of abnormal heart rhythm, atrial fibrillation, acute kidney injury, and blood clots in the lung (pulmonary embolism) in the group who received testosterone replacement therapy compared with those who used a placebo gel.

The FDA required the study was in 2015 in response to concerns and conflicting data regarding the safety of testosterone replacement therapy in men. It was conducted by a group of five manufacturers of testosterone replacement products, led by AbbVie. 

The findings were to be presented Saturday at ENDO 2023: The annual meeting of the Endocrine Society. The data was also published in the New England Journal of Medicine.