New Guidelines on Who Should and Shouldn’t Take Testosterone Therapy

April 17, 2018


According to the Endocrine Society, new scientific evidence shows that giving testosterone to men who don't need it is not a good idea. Well, I have to say that this is a pretty obvious statement. So, who could possibly disagree with that? But that's not all they had to say. And some of it is going to get you pretty upset.

The society published its recommendations in a guideline, entitled "Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline." Shalender Bhasin, MD, the chair of the task force that authored the guideline, concluded: "Recent surveys indicate many men are prescribed testosterone treatment without an appropriate diagnostic work up or monitoring plan. Some men receiving testosterone therapy do not have adequately documented hypogonadism [the ten-dollar word for testosterone deficiency], while others who have hypogonadism are not receiving the needed treatment." The guideline calls for avoiding testing and treating with testosterone unless they clearly need it. I absolutely agree. Here's why.

Hormones are not like nutrients. If you get more of a particular nutrient than you need, your body can quickly eliminate the extra without any problems. But if you get more of a hormone than you need, it will interfere with the way your body regulates hormone activity, and could easily cause problems. Some of the problems that can happen with testosterone therapy that isn't needed are blood clots, mood disorders, breast development, polycythemia (an excessive amount of red blood cells), and testicular shrinking. Why risk all of this simply to take a hormone that you don't need? But, here's the problem.

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How do you know if you need the hormone or not? Most doctors would say that it's easy. Just check the blood levels. But is that correct? The society recommendations point out the fact that blood levels are not all that accurate. About 30% of the time they are different when tested a second time. So, the recommendations are that the decision as to whether or not a man needs testosterone replacement should not be based purely on blood levels. Instead, the decision should be individualized. And should be guided by symptoms and the presence of certain disorders such as cardiovascular disease and diabetes which typically occur in men with testosterone deficiency. Once again, I agree with these guidelines.

The most common symptoms indicating a possible testosterone deficiency are decreased libido (desire for sex), decreased strength and stamina, depression, a decrease in motivation, a decreased enthusiasm about life, decreased mental function, erectile dysfunction, and decreased lean body mass. If a man has any or all of these symptoms, he probably warrants a three-month trial of testosterone therapy to see if the symptoms go away. If they do, the diagnosis of testosterone deficiency, or hypogonadism as the medical profession likes to call it, is confirmed. If they don't go away, then testosterone is not the cause, and the therapy should be stopped.

Please keep in mind that there are many cases of men with these symptoms that have nothing to do with testosterone deficiency. The same symptoms can be due to a poor diet, lack of fitness, sleep disturbances, obesity, medications, depression, excessive estrogen production, thyroid hormone deficiency, cardiovascular disease, insulin resistance, diabetes, and a host of other causes. So far, I am on the same page as the Endocrine Society. But, here's where I totally disagree with the new recommendations.

Unbelievably, according to the guidelines, men over the age of 65 should not be treated no matter how low their levels are! That's outrageous. But it's typical of a medical system that every year is limiting its focus more and more to the younger generation, while just assuming that anyone over 65 is over the hill and not all that worthy of being treated. If your doctor is like that, it's time to get another doctor. There is absolutely no reason I can think of why almost all of us can't be 90 years old and still able to have a sex life and climb some mountains. It's never how old you are, it's how well you function. And there's no doubt that men at any age function much better when their testosterone levels are optimal. And that's true no matter what the Endocrine Society says.

Yours for better health,


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