Testosterone Replacement Therapy

Testosterone Replacement Therapy (TRT) for men has gained significant widespread interest because of the profound effects of TRT for men with a testosterone deficiency. The sexual and non-sexual effects of testosterone deficiency can negatively affect quality of life and are associated with serious health concerns. It is recommended that low testosterone be considered in men with symptoms such as reduced libido, erectile dysfunction (ED), fatigue, a depressed mood, and poor concentration or memory.

Testosterone Safety

Testosterone is regarded as safe  in the medical research and has been demonstrated to have many benefits and many men on TRT will endorse that the sheer improvement in quality of life is one of the most profound benefits. But there are a number of documented side effects such as infertility, hair loss on the head, hair growth on the body, testicular atrophy, and a number of other issues that can be found in the drug reference for when testosterone is prescribed. There is ubiquitous health concern about testosterone regarding heart attack risk. But, this particular concern is probably unwarranted and the current scientific data do no support those concerns.

The Root of the Concern

There are nearly thirty years worth of scientific data that demonstrate having normal endogenous (made inside the body) testosterone levels, or the use of testosterone replacement, provides protective benefits against negative cardiovascular outcomes. This wasn’t challenged until two studies were published rapidly in succession in the end of 2013 and the beginning of 2014. These data brought up a considerable amount of undue concern and even resulted in the FDA labeling testosterone with a warning of heart attack risk. 

These studies have been disputed by many scientific advocacy groups based purely on the quality of the studies. Here’s an example of how the “funny math,” as it’s been called, is applied to the numbers of the 2013 study that was published in the Journal of the American Medical Association by R. Vigen, MD, and colleagues, in 2013. The conclusion of this study stated, “The use of testosterone therapy was associated with increased risk of adverse outcomes (heart attack, stroke, death).”

But let us take a more simple look at what actually happened in the study. There was a total of 8,709 men in the study. Some were placed on testosterone, but the majority were not. The study looked at the rate of events of death, heart attack, stroke. But the researchers analyzed the data with a wonky statistical method that’s not typically used in medical research to get their conclusion.

I like to look at what happened in a manner that we all understand. For example: if there are 100 questions on a really hard test, and you only get 20 correct, then 20 ÷ 100 = 20%. Let us look at the numbers like that. The numbers below come right from the study itself. Not on testosterone, the rate of events was 21.2%. On testosterone, the rate of events was 10.1%. Now, I’m not a rocket scientist or a mathematician; but, that is a 50% relative reduction in risk for those on testosterone. 

Not on Testosterone

On Testosterone

Total patients:

7,486

Total patients:

1,223

Deaths:

681

Deaths:

67

Heart attacks:

420

Heart attacks:

23

Strokes:

486

Strokes:

33

Total adverse events:

1,587

Total adverse events:

123

Rate of events:

1,587 ÷ 7,486 = 21.2%

Rate of events:

123 ÷ 1,223 = 10.1%

Validated by the Experts

But don’t take my word for it. If you have the time, watch this video by Abraham Morgentaler, MD, a Harvard trained Urologist and one of the world’s leading researchers on testosterone. 

Discussions About Your Health

If you have low testosterone, and your provider prescribes you testosterone supplementation, it’s important to have an open an honest conversation about all of the potential risk, benefits, and alternatives to testosterone replacement therapy. It’s also important to be in a position to educate yourself and be a good self-advocate.  

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