Dr. Scott Sanderson
Many of our patients are initially concerned regarding the safety of testosterone replacement therapy.
I want all of my patients to always be able to share any concerns with me and this is probably the most frequent question I hear.
A lot people have questions given what has been in the media recently. Unfortunately, the media tends to hype whatever will sell more papers rather than good science. Here is an excellent article from a very reputable source, the Mayo Clinic, that is very in depth. It reviews many scientific articles regarding the safety of testosterone replacement therapy.
It is quite long and full of a lot of medical jargon but bottom line up front – testosterone replacement therapy is safe and in fact actually beneficial to patients’ cardiovascular health. Like any medication, you must select the proper patient population and then provide monitoring after administration. This is no different from how I would treat any other prescribed medication.
Here is a little synopsis:
“Only 4 articles were identified that suggested increased CV risks with T prescriptions: 2 retrospective analyses with serious methodological limitations, 1 placebo-controlled trial with few major adverse cardiac events, and 1 meta-analysis that included questionable studies and events. ”
All of the studies that they found that suggested any risks with testosterone therapy were significantly flawed studies. This is something the media will never tell you. They do not analyze the studies for quality, they only cover them if it makes an interesting headline.
“In contrast, several dozen studies have reported a beneficial effect of normal T levels on CV (cardiovascular) risks and mortality. Mortality and incident coronary artery disease are inversely associated with serum T concentrations (LOE IIa), as is severity of coronary artery disease (LOE IIa). Testosterone therapy is associated with reduced obesity, fat mass, and waist circumference (LOE Ib) and also improves glycemic control (LOE IIa). Mortality was reduced with T therapy in 2 retrospective studies.”
Inversely associated means that as testosterone levels increased, mortality and incident coronary artery disease decreased. Other studies showed multiple other benefits including the biggest of all – decreased mortality.
“Several RCTs in men with coronary artery disease or heart failure reported improved function in men who received T compared with placebo. The largest meta-analysis to date revealed no increase in CV risks in men who received T and reduced CV risk among those with metabolic disease.”
RCT stands for randomized controlled trial. It is the gold standard for design in a medical study. So the best type of scientific study that there is found improved heart function. A meta-analysis is when we take a bunch of studies and combine them and look at their aggregate findings. When done properly, this is a very powerful method because it gathers data from many patients. This well done meta-analysis shows reduced CV (cardiovascular) risk.
After looking at the evidence, I believe that testosterone therapy it is truly safe and actually quite beneficial. Like all medical therapies, it must be done correctly and with close monitoring. This is why I believe that all of these “low T” clinics that you see popping up all over the place are unsafe. I do not believe that they do a thorough enough evaluation of their patients and they do not provide close monitoring. They also only evaluate one hormone (we evaluate almost a dozen). Optimized hormones are only one aspect of healthy aging. Our program is founded on the most thorough evaluation available, a fully individualized plan and very close monitoring by your physician, exercise counselor and nutritionist.