Here is a blog post of mine about testosterone from an update. The experts now agree! (See the attached PDF with new consensus guidelines).

There’s an apocryphal story in medicine that goes like this:

An eminent professor concluded his speech to the graduating class with the following comment:

“Ladies and Gentlemen, 50% of everything we have taught you about medicine is wrong, the trouble is, at the moment, we don’t know which 50%. Your job is to work it out”

In medicine we have interesting, and contradictory, positions with respect to hormone replacement.

In women we recognise a condition called menopause, which happens to women in their 40s and 50s when the levels of the hormones oestrogen and progesterone fall rapidly and the menstrual cycle becomes first erratic, then stops altogether.

We know that many women get symptomatic relief from symptoms of menopause like hot flushes, night sweats, and mood swings if we give them small doses of these missing hormones.

In men the situation is a little different. Testosterone is the primary male hormone, and levels start falling more or less immediately after sexual maturity is reached in the early 20s.

It has taken medical science a long time to get it’s head around thinking that males also experience a form or menopause, which some people call Andropause. Perhaps it’s because the decline is so slow, or it’s because there is no obvious “change of life”, other than the pervasive male middle aged spread?

We are now at the point where it has been found that men with Testosterone levels in the lowest 25% actually have the highest levels of cardiovascular mortality – ie die from strokes and heart attacks

Furthermore supplemental testosterone is safe for cardiovascular health, according to research presented at a meeting of the American Heart Association in Chicago.

It shows men on supplementation have reduced overall rates of major adverse cardiac events at one and three years after their initial low levels of testosterone were measured compared with men with persistently low levels of testosterone.

The study results coincide with an FDA evaluation of the safety of testosterone supplementation and whether it is a risk to the health of older men.

The researchers say it provides reassurance to doctors who can use testosterone with less concern about its effect on patients’ heart health.

“With this study we are getting closer to defining the true associations between testosterone treatment and cardiovascular risks or benefits,” says study leader Jeffrey Anderson, a cardiologist at the Intermountain Medical Center Heart Institute.

So if you’re a man, battling middle aged spread and loss of libido perhaps you should talk to your doctor about having you testosterone level measured, and if it’s low, considering supplementation?

FundamentalConceptsRegardingTestosterone.pdf

Read this a while back – Boosting testosterone doesn’t do much for flagging sex life or low energy, research finds
Although if you read the source quoted in that article, it says improvement was noted in sex life, but not overall vitality – http://www.nejm.org/doi/full/10.1056/NEJMoa1506119#t=abstract

Damn reporters should read what they are reporting on.

My experience is anecdotal – ie what patients tell me after we make the diagnosis of low testosterone and fix the problem – and it’s quite similar to what happens to most patients with symptomatic HCV. Treatment makes people feel better. It’s a nice gift to be able to give.

The medical profession remains very split on testosterone but it seems the tide is turning although the Australian Endocrine Society has recently issued advice that flies in the face of recent international opinion.

The normal range – 28 (at age 1 to 8 (at age 80) seems a problem. It seems like it should be age adjusted so 20-40 in the 20s, 15-30 in the 40s and 8-20 in the 60s would be more in line with the question “Is this person normal/deficient for age”. With things like blood pressure we do have different values for different age people because what’s normal for a child is too low for an adult and with age higher blood pressures become normal as the arteries harden.

The clinical profile I’ve seen anecdotally is depression, low libido, elevated triglycerides along with more common things like weight gain, diabetes and hypertension. I’ve seen that profile go back to fit and well with testosterone in patients who hit the previous limit of <8 (it's now <6 for government funding). I've seen a few patients in the low double digits, started on testosterone by themselves (Internet) or others report similar things, but mindful of not being too far outside the envelope limit myself to patients with single digit levels in line with the old guidelines.