Dr. Abraham Morgentaler, an Associate Clinical Professor at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, MA, gives an overview of his article appearing in the July 2016 issue of Mayo Clinic Proceedings regarding the results of an international consensus meeting held in Prague, Czech Republic, on October 1, 2015. A panel of International experts reached unanimous approval of 9 fundamental concepts regarding testosterone deficiency and testosterone therapy based on the scientific evidence. Available at: http://tinyurl.com/zpapqwr
[TH]Concerns regarding TD and T therapy that have appeared in the scientific and lay media[/TH]
[TH]Expert responses[/TH]
•The condition of low T does not exist
False. [style=font-style:italic;]Low T[/style] is an informal term used to describe TD, much as “heart attack” is used in place of myocardial infarction. TD is a well-established medical condition described in all general medical textbooks
•The symptoms of TD do not merit treatment, particularly decreased libido and fatigue
The symptoms of TD are of considerable importance to many affected men. However, decisions regarding treatment must be individualized
•T therapy is risky
All medical treatments entail some degree of risk. Known risks of T therapy include acne, gynecomastia, peripheral edema, infertility, decreased testicular volume, and erythrocytosis. These are reversible with discontinuation of treatment. The evidence fails to support assertions that T therapy is associated with increased CV risk or PCa
•T therapy increases risks of VTE, such as deep venous thrombosis or pulmonary emboli
Available evidence reveals no increased risk of VTE with T therapy62
•T therapy increases the risk of myocardial infarction, stroke, and death
Two flawed studies reporting increased CV risk with T therapy received enormous media attention. One misreported primary results1 and the other2 had no control/comparison group. In contrast, several dozen studies provide high-level evidence that reduced T concentrations are associated with increased CV events and atherosclerosis, whereas T therapy appears to reduce CV risk or improve known CV risk factors16
•T therapy causes PCa to develop or become aggressive
Not supported by evidence. Longitudinal data reveal no relationship between higher serum T level and PCa risk.64 Meta-analyses found no greater risk of PCa in men who received T therapy compared with placebo.65 High-grade disease and poor prognostic PCa features are associated with [style=font-style:italic;]low[/style] serum T concentrations63
•T therapy is experimental/investigational
False. T therapy has been a standard form of medical treatment for men with TD for more than 70 years, with numerous studies documenting benefits and a reasonable safety profile16, 20
•The decline in T is due to normal aging and does not merit treatment
Age alone has little impact on serum T concentrations. Most of the age-associated decline in serum T levels is associated with development of comorbidities, especially obesity.17 Many important medical conditions are age related, including coronary artery disease, diabetes, arthritis, cataracts, and most adult cancers. We find no justification to single out TD as a condition that does not merit treatment because it becomes more prevalent with age
CV = cardiovascular; PCa = prostate cancer; T = testosterone; TD = testosterone deficiency; VTE = venothrombotic events.
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