This is Part II to my response on the recent Milwaukee Journal Sentinel article regarding testosterone (T) replacement with the headline, "UW tied to male hormone marketing: Testosterone prescriptions soar despite weak research, risks." Here's a link:
http://www.jsonline.com/features/health/52802117.html
It is my practice to measure testosterone levels on all my patients presenting with erectile dysfunction. We know that testosterone is needed for all sexual function from libido to erection to orgasm. Here I present evidence on the role of testosterone on erectile function. I will also address the claims that testosterone does not affect mood or energy levels or their bodies.
According to the article:
“... there is so little evidence to back up the claim that supplements … help men 45 and older buck up their sex lives, moods, energy levels or bodies.”
Here are some studies for you to consider.
Testosterone and sex lives:
Erectile dysfunction and testosterone deficiency.
Blute M, Hakimian P, Kashanian J, Shteynshluyger A, Lee M, Shabsigh R
Frontiers of Hormone Research. 37:108-22, 2009
Testosterone replacement alone in hypogonadal men can restore erectile function. A significant proportion of men who fail to respond to a PDE5 inhibitor are testosterone deficient. Testosterone replacement therapy can convert over half of these men into phosphodiesterase type 5 responders. It is now recommended that testosterone levels should be assessed in all patients with erectile dysfunction.
Endothelial effects of drugs designed to treat erectile dysfunction.
Aversa A, Caprio M, Rosano GM, Spera G
Current Pharmaceutical Design. 14(35):3768-78, 2008
… endothelial dysfunction is present in testosterone deficiency syndromes and replacement therapy is able to revert ED and to improve endothelial function.
Testosterone and moodEffects of Testosterone Replacement in Middle-Aged Men With Dysthymia: A Randomized, Placebo-Controlled Clinical Trial
Seidman, Stuart N. MD; Orr, Guy MD; Raviv, Gil MD; Levi, Rachel BA; Roose, Steven P. MD; Kravitz, Efrat BSc; Amiaz, Revital MD; Weiser, Mark MD
Journal of Clinical Psychopharmacology
Issue: Volume 29(3), June 2009, pp 216-221
Testosterone replacement may be an effective antidepressant strategy for late-onset male dysthymia.
Comparison of long-acting testosterone undecanoate formulation versus testosterone enanthate on sexual function and mood in hypogonadal men.
Jockenhovel F., Minnemann T., Schubert M., Freude S., Hubler D., Schumann C., Christoph A., Ernst M.
European Journal of Endocrinology. 160(5):815-9, 2009 May.
Among the 12 items of subjective mood assessment, agitation, self-confidence, activation, good mood and concentration showed a significant improvement during the treatment and further significant improvement during follow-up with TU treatment. The other items, i.e. sociability, listlessness, dizziness, depression, fatigue, anxiety, and aggressivity, improved too, but not significantly. This tendency was the same during the follow-up with treatment with TU.
Partial androgen deficiency, depression and testosterone treatment in aging men.
Amore M, Scarlatti F, Quarta AL, Tagariello P
Aging-Clinical & Experimental Research. 21(1):1-8, 2009 Feb
Abstract: This study provides a critical review of the literature on depressive symptoms of partial androgen deficiency (PADAM) and their treatment with Testosterone (T). PADAM in aging males is responsible for a variety of behavioral symptoms, such as weakness, decreased libido and erectile dysfunction, lower psychological vitality, depressive mood, anxiety, insomnia, difficulty in concentrating, and memory impairment. The psychological and behavioural aspects of PADAM may overlap with signs and symptoms of major depression. Evidence of the relationship between androgen deficiency and male depression comes from studies that have assessed depression in hypogonadal subjects, the association between low T level and male depressive illness, and the antidepressant action of androgen replacement.
Although data derived from androgen treatment trials and androgen replacement do not support T treatment or replacement as more efficacious than placebo for major depressive disorder (MDD), the clinical impression is that, in some sub-threshold depressive syndromes, T may lead to antidepressant benefits.
Testosterone and bodies:
Low bone density and high percentage of body fat among men who were treated with androgen deprivation therapy for prostate carcinoma.
Chen Z, Maricic M, Nguyen P, Ahmann FR, Bruhn R, Dalkin BL.
Cancer. 2002;95: 2136 –2144
Chen et al (2002) investigated the effect of androgen deprivation (removing testosterone) on total body fat mass after 1–5 years of treatment in 62 men with prostate cancer. There was a significant increase in total body fat mass and reduction in lean body mass.
Effects of Testosterone Administration on Fat Distribution, Insulin Sensitivity, and Atherosclerosis Progression
Shalender Bhasin
Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine Science, University of California — Los Angeles School of Medicine
Clinical Infectious Diseases 2003;37:S142–S149
In spite of the widespread belief that testosterone supplementation increases the risk of atherosclerotic heart disease, evidence to support this premise is lacking. Although supraphysiological doses of testosterone, such as those used by athletes and recreational body builders, decrease plasma high‐density lipoprotein (HDL) cholesterol concentrations, replacement doses of testosterone have had only a modest or no effect on plasma HDL in placebo‐controlled trials. In epidemiological studies, serum total and free testosterone concentrations have been inversely correlated with intra‐abdominal fat mass, risk of coronary artery disease, and type 2 diabetes mellitus. Testosterone administration to middle‐aged men is associated with decreased visceral fat and glucose concentrations and increased insulin sensitivity. Testosterone infusion increases coronary blood flow. Similarly, testosterone replacement retards atherogenesis in experimental models of atherosclerosis.
Testosterone and growth hormone improve body composition and muscle performance in older men.
Sattler FR., Castaneda-Sceppa C., Binder EF., Schroeder ET., Wang Y., Bhasin S., Kawakubo M., Stewart Y., Yarasheski KE., Ulloor J. Colletti P., Roubenoff R., Azen SP.
Journal of Clinical Endocrinology & Metabolism. 94(6):1991-2001, 2009 Jun.
Supplemental testosterone produced significant gains in total and appendicular lean mass, muscle strength, and aerobic endurance with significant reductions in whole-body and trunk fat.
The management of hypogonadism in aging male patients.
Sharma V, Perros P
Postgraduate Medicine. 121(1):113-21, 2009 Jan
Several studies indicate that testosterone replacement therapy may produce a wide range of benefits for men with hypogonadism, including improvement in libido, bone density, muscle mass, body composition, mood, and cognition.
The Journal Sentinel's claims that "one key problem is that there is a lack of scientific evidence that men over the age of 45 benefit from taking testosterone" is simply untrue. I have presented numerous articles in these posts, all based on scientific and medical research and publications disclaiming their assertion. It is unfortunate that patients are misguided by these articles. Patients should be cautious of what they read in the newspapers and they should always consult their physicians regarding their care and what they read before acting on their own.
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The following is feedback received for this blog:
Dr. K - Thanks for writing this rebuttal on that article. Do you know if middle-aged men can do something to increase T without having the actual hormone injections? Something "natural?"
- Don
Despite claims that the benefits of testosterone replacement therapy aren't supported by research, I have all the evidence I need. I use it myself and, believe me, it works.
A daily dose of Testim 1% has significantly improved my sex drive and sexual function. It has given me a sense of mental clarity and accuity that many 50-something men seem to lack. It has dramatically raised my energy level and helped me to add lean muscle mass instead of fat.
It may not be the fountain of youth, but it has improved the quality of my life, and that's good enough for me.
- Kiernan B.
Don,
Yes, there have been studies that show increasing muscle mass can increase testosterone production. So start exercising and pumping iron!
- Dr. Kressin |