Search for fountain of youth drives testosterone replacement industry

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic leader on aging. Her work has appeared in, Journal of Active Aging, Cancer Today, Kaiser Health News and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: Maxwell GS via Flickr

You know those ads on late-night radio or in the back of some magazines for testosterone replacement therapy? Hate to be the bearer of bad news, but for older men that’s no real path to a male fountain of youth.

Like it or not, low testosterone is a normal part of aging and “fixing” it can be risky. Despite some news reports on the benefits of testosterone replacement therapy, several recent studies show that the harms may outweigh benefits.

Testosterone is the male sex hormone responsible for facial and body hair, deep voices, strong bones and, importantly, development of reproductive tissues such as the testis and prostate. Testosterone levels peak in early adulthood and drop about one to two percent annually after that, according to Harvard Health, By age 50, many men notice physical changes such as decreasing libido, impotence, reduced muscle mass and even hot flashes. (Yes, men can get them too). Certain medications, such treatments for cancer, obesity and some other chronic conditions can accelerate the process.

To offset these declines, some men have turned to testosterone replacement therapy. It’s available in many forms, including patches, injections, pills, and nasal sprays. While many men report a relatively quick improvement in sex drive and mood, these results come with other hazards. Recent research shows that T therapy has been linked to faster growth of precancerous cells, testicular shrinkage and infertility, as this Men’s Fitness article explains. The latest studies also indicate that while testosterone therapy provides some additional health benefits, including improving anemia and increasing bone density, it did not do much for memory or cognitive function.

However, the most serious side effect researchers found was the risk of an increase in red blood cells that could lead to heart attack or stroke. Researchers found that 138 study subjects showed increased plaque build-up in coronary arteries, as Andrew Seaman reported for Reuters, This study counters the conclusions of a large 2015 study of 83,000 veterans that showed a reduction in mortality, heart attack and stroke.

Despite this, testosterone replacement has become a lucrative, $2 billion industry for large drug companies such as AbbVie and Eli Lilly, according to The Guardian. Critics say these companies prey on men who are eager to regain their youthful vigor despite scant long-term evidence of success and these recent findings of potential harm.

Revised labeling from the FDA cautions that testosterone replacement is approved only for men with certain medical conditions, such as hypogonadism. They warn that it should not be used for normal hormonal declines due to aging.

It is still not clear what the long-term risks and benefits are of this therapy, although The Guardian’s headline was unequivocal: “ Researchers say there are no benefits of testosterone treatments for men.”

What does the scientific community think? As this 2016 Scientific American article from Bob Roehr points out, researchers are not overly optimistic about the role of testosterone replacement as a panacea, but at least physicians and older patients may start talking about underlying conditions and the therapy’s benefits versus risks.

When reporting on this issue, be aware that study conclusions differ and few long-term studies of testosterone therapy exist. Also, many over-the-counter supplements sold on late night TV or in health food stores are not regulated by the FDA. Make note of marketing efforts that promote the idea that “low T” can be “fixed” without side effects.

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