Recognizing the True Value of Testosterone Therapy in Health Care

Buy Lab Tests Online

madman

Super Moderator
Recognizing the True Value of Testosterone Therapy in Health Care (2022)
Abraham Morgentaler, * Abdulmaged Traish, Rajat S. Barua, Paresh Dandona, Sandeep Dhindsa, Mohit Khera, and Farid Saad


Abstract

There has been little recognition within the medical community of the health impact of testosterone (T) deficiency (TD), also known as hypogonadism, and the substantial benefits of testosterone therapy (TTh) on health and quality of life despite high-level clinical evidence. In a roundtable symposium, investigators summarized the contemporary evidence in several key clinical areas. TD negatively impacts human health and quality of life and is associated with increased mortality. Several studies have demonstrated that TTh in men with TD reduced all-cause and cardiovascular mortality. The longstanding belief that TTh is associated with increased prostate cancer (PCa) risk is contradicted by recent evidence, including multiple studies showing that TTh is associated with reduced PCa risk. Similarly, the weight of current evidence indicates the purported concern that TTh is associated with increased cardiovascular risk is incorrect. Normalization of physiological T reduces myocardial infarction, stroke, and deaths compared with men whose testosterone levels failed to normalize. In diabetic men, TTh improves insulin resistance, and a large 2-year controlled study in men with abnormal glucose tolerance showed a substantially reduced rate of diabetes among men treated with TTh compared with untreated controls. Long-term TTh in diabetic men resulted in progressive improvements in obesity and insulin requirements, including a substantial number who experienced complete remission of diabetes. Finally, TTh has been shown to reduce severe outcomes with Covid-19 infection. These lines of evidence argue strongly for the need for greater awareness in the medical community of the impact of TD on health, and of the health benefits of TTh.




Introduction

Despite high-level evidence demonstrating the health risks of testosterone (T) deficiency (TD, also known as hypogonadism) in men and the substantial benefits of testosterone therapy (TTh), there has been little recognition of the true value of TTh in medicine. The purpose of this article is to highlight several key topics that together provide a powerful argument that TD and TTh merit greater awareness in the medical community

Testosterone is a ubiquitous molecule among vertebrates, leading to tens of thousands of research studies exploring its effects in animals. The effects of castration on muscle, fat, and sexual behavior have been recognized in humans and domesticated animal species for millennia.1 The androgen receptor, a key molecule that mediates the effects of androgens in most human tissues, has been identified in a remarkably broad range of tissues, including but not limited to muscle, bone, bone marrow, the peripheral and central nervous system, adipocytes, liver, kidney, skin, and testis.2 No wonder, then, that a deficiency of testosterone has been shown to have numerous negative effects in men, which may be improved or reversed with the normalization of serum testosterone through TTh.

Although health care providers (HCPs) may have a general awareness that testosterone is important for male sexual desire and muscle mass, it is not widely appreciated that (1) TD is associated with several of the most important general medical conditions facing our society, including type 2 diabetes mellitus (T2DM), obesity, osteoporosis, and cardiovascular (CV) disease, and (2) TTh has shown compelling health benefits for those conditions, among others.
Testosterone levels have been associated with the most urgent global medical issue of the past several years, namely COVID-19 infection,3 and TTh have even been shown to reduce the rate of severe infection.4 Mortality has been shown to be associated with low levels of testosterone,5 and observational studies have shown a twofold decrease in mortality among men with TD that received TTh.6,7

*Despite these impressive results, it is curious that few HCPs, medical researchers, or health administrators are aware of these potential benefits of TTh. This lack of recognition represents a troubling blind spot in academic medicine. Indeed, correcting this deficiency has the potential to improve health for millions of men in the United States alone, and to save billions of dollars in health care costs.





The Most Misunderstood Molecule in Medicine

Academic medicine and professional specialty medical organizations place tremendous value on high-quality research studies to create clinical guidelines and recommendations. Yet this open-minded approach to new and evolving information seems to not apply to studies involving TTh.

In the pages that follow are summaries of evidence showing that TTh has important beneficial effects on several of the most common and costly medical conditions, including metabolic disease and obesity, T2DM, and CV disease. Many of these studies have been published in high-impact medical journals by highly regarded investigators. However, these studies are rarely cited in clinical guidelines, with many neglecting even to mention TTh as a possible option.

*In this study, we provide summaries of selected key areas of testosterone research to provide a scientific basis for the argument that TD is an important health risk and TTh offers valuable healthcare benefits with a reassuring safety profile.





Testosterone Deficiency Is a Serious Health Concern and TTh Improves Signs and Symptoms Associated with TD

Testosterone is a metabolic, sexual, and vascular hormone that plays an important metabolic function in many organs, and plays a key role in human physiology and health. A deficiency of testosterone has been shown to have detrimental effects on men’s health and negatively impact the quality of life.15 The signs and symptoms of TD encompass sexual, physical, psychological, and cognitive domains.




TTh May Be Protective and Therapeutic for Prostate Cancer

Since the early 1940s, it was believed that TTh increased the risk of prostate cancer. In fact, many clinicians were taught that TTh was similar to ‘‘adding fuel to the fire’’ of prostate cancer. It was not until the turn of the century that this paradigm began to shift. For the past 20 years, our beliefs of TTh have shifted from TTh being dangerous, to be safe, to potentially therapeutic, and now to being potentially protective against prostate cancer.

Although for decades it was believed that TTh increased the risk of developing prostate cancer, we have now entered an era where TTh is being used in clinical trials for potential therapeutic and protective effects. Although more studies are needed to better understand this protective and therapeutic relationship between TTh and prostate cancer, it is now evident that prostate cancer can no longer be considered a risk of TTh.





TTh Is a Potentially Valuable Treatment in T2DM

In a study of 103 men with T2DM, 33% were found to have TD.25 These men had low total and free testosterone concentrations, along with inappropriately low or normal concentrations of luteinizing hormone and follicle-stimulating hormone, categorizing them as having hypogonadotropic hypogonadism (HH). Testosterone concentrations were found to have an inverse relationship with BMI but were not related to glycated hemoglobin (HbA1c) or the duration of diabetes. Nondiabetic obese men have a prevalence of HH in 25%.26 Thus, this is the most common cause of hypogonadism in the community.

*Clearly, therefore, testosterone should be measured in all type 2 diabetes and obese patients. If testosterone concentrations are found to be low, TTh has to be considered not only for its beneficial effects on sexual function but also for its metabolic effects that are profound and widespread. Recognition of the value of TTh in diabetes is evolving—one major professional society recommends its use when TD is present, whereas a second advocate testing for testosterone in men with symptoms of TD but does not yet recommend treatment.29,30





Long-Term Benefits of TTh

Most randomized controlled trials involving TTh have been of short duration. In one meta-analysis, one-third of the studies had a duration of 3 months or less. Still, the meta-analysis showed robust effects of TTh on reduction in fat mass, increase in lean mass, improved fasting glucose, and insulin resistance.31




Normalization of Testosterone in Men Is Associated with Reduced Heart Disease

Testosterone exerts a multitude of effects on CV physiology. At physiological levels, T increases coronary vasodilatation and coronary blood flow, improves vascular reactivity, and shortens corrected QT interval. All these effects likely play a role in the mitigation of CV risk.36 Indeed, observational studies demonstrated that low T levels were associated with poor clinical CV outcomes such as increased mortality and MI.36,37 However, the role of TTh has been controversial, as several studies have suggested poor CV outcomes and adverse effects with TTh.35,36 However, no clinical trials of TTh published to date have been adequately powered to assess CV events. Furthermore, published studies have not specifically evaluated whether TTh resulted in the normalization of T levels.

*In summary, the scientific evidence indicates that low T concentrations are associated with increased mortality and CV events. In men with TD without prior CV events (MI, stroke, and AF), normalization of serum T with TTh is associated with decreased mortality, MI, stroke, and AF. Ongoing cigarette smoking nullifies the MI benefit of normalization of T levels. In men with TD with previous MI, normalization of T with TTh is associated with decreased mortality and is not associated with a greater risk of MI.40





TTh Is Associated with Reduced Severe Outcomes from COVID-19

Since the start of the COVID-19 pandemic, it has been consistently noticed that patients hospitalized with COVID-19 are more likely to be men than women.42 As such, it was presumed that the male sex hormone, testosterone, is a risk factor for severe COVID-19 infections.43 However, there is wide variability of serum testosterone concentrations among men.44,45 Aging and the presence of comorbidities, which are themselves risk factors for hospitalization from COVID-19, are also associated with TD. Men with chronically low testosterone have weaker muscle mass and strength, which contribute to reduced lung capacity.46 This raises the question of whether TD is a risk factor for severe COVID-19 illness.

*These results indicate that (1) TD in men should be considered a risk factor for severe COVID, and (2) prospective clinical trials are needed to explore the efficacy of TTh in preventing hospitalizations after COVID-19 and similar respiratory illnesses in men with TD.





Discussion

In this article, we have provided brief selected reviews of several key topics related to TD or TTh. In several instances, the reviews focus on research performed by one or more of the authors themselves. The information provided in this study amply demonstrates the health impacts of TD and the multiple benefits of TTh across a range of critical health conditions, including T2DM, obesity, CV disease, and COVID-19 infection. In addition, the evidence presented in this study provides reassuring data regarding TTh safety, addressing, in particular, the two most common concerns, namely the risks of prostate cancer and CV disease. Interestingly, current evidence suggests that TTh in men with TD may actually reduce risk in these areas.

Despite these impressive research results there remains considerable skepticism regarding the utility of TTh in the medical community. The FDA has added to this skeptical attitude by minimizing the benefits of TTh in its assessment of the Testosterone Trials and by adding new restrictions for the indications of TTh. Although the FDA does not regulate the practice of medicine, it is widely regarded as a reliable authority, and its statements carry enormous weight, even when experts in the field disagree with the FDA’s conclusions.

We believe the evidence presented in this study supports the position that the importance of TD in health care and the benefits of TTh in these men is underrecognized and underappreciated.

We encourage HCPs to become more familiar with this literature. Greater awareness can be expected to lead to improved health and reduced healthcare costs for our society.
 

Attachments

  • andro.2022.0021.pdf
    551.6 KB · Views: 32
Defy Medical TRT clinic doctor
Buy Lab Tests Online
Defy Medical TRT clinic

Sponsors

enclomiphene
nelson vergel coaching for men
Discounted Labs
TRT in UK Balance my hormones
Testosterone books nelson vergel
Register on ExcelMale.com
Trimix HCG Offer Excelmale
Thumos USA men's mentoring and coaching
Testosterone TRT HRT Doctor Near Me

Online statistics

Members online
9
Guests online
6
Total visitors
15

Latest posts

bodybuilder test discounted labs
Top