Flawed Testosterone Analysis Spurs Misleading Media Headlines

[Dave Barry]

The following link provides an extensive rebuttal to the media reports associating testosterone treatment with greater heart attack risk.

Here is a summary of the study as seen through the eyes of the Cleveland Clinic: http://health.clevelandclinic.org/2013/11/concerns-raised-about-testosterone-therapy/

Here is a summary of the rebuttal from the Life Extension Clinic.

Here is the summary:
"1) In order to protect against heart disease, total testosterone blood levels need to be raised higher than 500–550 ng/dL. Life Extension believes that optimal youthful total testosterone is in the 700–900 ng/dL range.

The men enrolled in this flawed study only boosted their mean total testosterone levels to 332 ng/dL. Previous studies show this low testosterone level (332 ng/dL) is associated with an increased heart attack risk compared with levels above 500–550 ng/dL.
2) The men in this study were not properly individually dosed and monitored, which explains why the testosterone treatment they received failed to restore their blood testosterone levels to anywhere near cardio-protective ranges.
3) Estradiol (an estrogen) blood levels were not reported in this study used to discredit testosterone drugs. A subset of aging men, often with increased visceral body fat (body fat around the internal organs of the abdominal cavity), have a tendency to convert testosterone into excess estrogen. This excess estrogen may alter the balance of anticoagulant and procoagulant (clotting) factors in the blood, and potentially enhance the risk of heart attack and stroke. Any man treated with testosterone drugs should also have his estradiol blood level tested to ensure that the testosterone is not excessively converting to estrogen. If estradiol increases excessively, then low-dose aromatase-inhibiting drugs (such as 1 mg/week of anastrozole [Arimidex[SUP]®[/SUP]]) can be prescribed to reduce the conversion of testosterone to estrogen.
A subgroup of overweight men with excess visceral body fat treated with testosterone in this study would be expected to excessively convert (aromatize) their testosterone into estrogen, which may help explain why more men in the testosterone group suffered a greater percentage of heart attacks.
Research published in 2013 shows profound cardiovascular benefits in response to higher testosterone levels (in men). The media conveniently ignored these positive reports and narrowly focused on the egregiously flawed study published in the Journal of the American Medical Association (JAMA).

Based on many published studies, Life Extension has recommended for decades that aging men restore testosterone to a youthful range. We've always warned that for some men restoring one's testosterone to more youthful levels could create excessive levels of estrogen, which is readily detectable by blood testing and reversible using aromatase-inhibiting therapies.
What's most frightening is that most mainstream doctors today are blindly prescribing testosterone drugs and omitting any kind of estrogen testing. This creates a very dangerous environment for men who excessively convert their testosterone into excess estrogen!"

Full rebuttal below:


http://www.lef.org/featured-article...08&utm_content=text_link&utm_campaign=INL303E

 

[Nelson Vergel]

A restrospective study published this week on the Journal of American Medical Association concluded that testosterone may increase the risk of cardiovascular problems in men with a history of heart disease. This study performed at the Venteran’s Administration hospital sysmtem cautioned that men with pre-existing cardiovascular ailments who have low blood levels of testosterone (hypogonadism) might need to avoid testosterone replacement therapy (TRT) even if they need it to improve their lives.

Several published studies have found that untreated prolonged low testosterone blood levels can increase the risk of cardiovascular disease. Although the men in this study were treated mostly with testosterone skin patches, their blood levels of testosterone never increased to desirable levels. Even more concerning is the fact that the study failed to monitor 40 % of these patients who never had their testosterone blood levels retested after they started TRT . A recently published study showed that men with total testosterone (TT) blood levels below 550 ng/dl had a significant increase in their risk of cardiovascular disease, while men with TT above 550 ng/dl reduced their risk by 30%. Most participants in this study were only able to increase their TT levels to 332 ng/dl, a level that still classifies them as having testosterone deficiency.

Another pitfall of this study is that it did not manage hematocrit (red blood cell volume) and estradiol ( a female hormone produced by testosterone’s conversion in the body). High levels of hematocrit and estradiol can increase cardiovascular risks. However, both estradiol and hematocrit are easily managed when a comprehensive TRT protocol is used to prevent these side effects.

The majority of participants in this study used testosterone patches. Once a popular method of testosterone delivery, testosterone patches are no longer used due to their poor absorption and inconvenience. Patches are highly inefficient in terms of optimizing testosterone, resulting in continued hypogonadal symptoms and increased cardiovascular risk.

Perhaps the most startling piece of the study that was missed altogether or largely ignored by most reports was the rate of reported cardiovascular events. After close scrutiny of study results it is easily discerned that of those men who used testosterone, 10% experienced a cardiovascular event. Of those men not taking testosterone, 21% experienced a cardiovascular event. The rate of mortality was greater in those who did not take testosterone.

Publishing studies with these many deficiencies that recommend not treating men who could benefit from testosterone replacement therapy increases the misconceptions surrounding this important therapy and alarms men currently on TRT. We caution physicians and patients alike to closely examine studies for any misleading information that could increase barriers to access to therapies that can considerably improve quality of life, mortality and morbidity of hypogonadal men.