Testosterone Can be Used Safely
by Edward Friedman, Ph.D.

Testosterone is Safe for Women

Testosterone is Safe for Men

There was a recent article pointing out supposed bad effects of testosterone in men that might explain why doctors avoid using it. The list includes sleep apnea, prostate cancer, BPH, liver problems, congestive heart failure, and enlarged breasts. This certainly sounds scary, but the reality is that the only real danger, when estradiol levels are optimized, is too much red blood cell production - something that is readily treatable by bleeding or by reducing the testosterone dosage. The problem is that estradiol levels are rarely optimized when giving testosterone. This is especially dangerous in elderly men because aromatase activity (which converts testosterone to estradiol) increases with age, so adding testosterone will typically significantly raise estradiol levels.

Sleep Apnea

First let's look at sleep apnea. Sleep apnea is actually correlated with too little testosterone. There are a few cases where apnea was worsened when testosterone was given, but those studies never measured estradiol levels nor tried to prevent the added testosterone from being converted to estradiol. At this time, no definitive studies have yet been done which would reveal the effect on sleep apnea of increasing testosterone levels only.

Prostate Cancer

Next, let's look at prostate cancer. It is impossible to get prostate cancer without functioning estrogen receptor-alpha, so if you prevent testosterone from being converted to estrogen (testosterone does not bind to estrogen receptor-alpha), then it is impossible for testosterone to cause prostate cancer. In fact this combination should prevent prostate cancer.

BPH

BPH is an interesting case. Dr. Wells Farnsworth showed that estrogen was the main culprit in BPH. Again, using a drug to stop the conversion of testosterone to estradiol should stop any increase in BPH.

Liver Problems

Liver problems are known to be associated with oral ingestion of testosterone, which is something I am totally opposed to. In fact, when used properly, testosterone actually improves liver function.

Congestive Heart Failure

Congestive heart failure is associated with either too little or too much estradiol as well as with too little testosterone (as covered in my book). The only time experiments showed an increase in congestive heart failure in men taking testosterone was when nothing was done to prevent the accompanying increase in estradiol known to occur when men take testosterone - especially in older men - and nothing is done to monitor and control hematocrit levels. When you look at endogenous levels of hormones, too much estradiol, but not testosterone, is associated with increased coronary heart disease. There have been recent papers that have gained attention in the mainstream media which claim that testosterone causes adverse cardiac events. An editorial in the February, 2015 issue of Mayo Clinic Proceedings praises Dr. Morgentaler's article in that issue which debunks the studies that the mainstream media have been touting.

A 2015 study showed that men who received testosterone supplementation experienced a 7-fold reduction in heart attacks and a 9-fold reduction in strokes.

The most recent study, published in September 2017, was an 8 year observational registry study with 360 hypogonadal men receiving testosterone and 296 control hypogonadal men who didn't. There were 2 deaths in the treated group (1 from an automobile accident) with none from cardiovascular causes. In fact, there were no adverse cardiovascular incidents in any of the treated men. There were 21 deaths in the untreated men, 19 of which were from cardiovascular causes. In addition, there were 26 nonfatal myocardial infarctions and 30 nonfatal strokes in the untreated group. The treated group also experienced improvements in all of the known cardiovascular risk factors.

The most recent meta analysis looked at all random placebo-controlled trials that measured specific cardiovascular features. The men who received testosterone improved in almost all features.

Enlarged Breasts

Enlarged breasts are known to be caused by too much estradiol. I find it barbaric that doctors actually radiate the breasts to shrink them when they grow after men are given testosterone. The sensible alternative is to prevent the testosterone from being converted to estrogen in order to prevent enlarged breasts.

Diabetes

An 8 year study showed that prediabetic hypogonadal men who received testosterone had 0% develop diabetes. Those who didn't had 40.2% develop diabetes.

Blood Clots

Another danger commonly mentioned, but not discussed in the above article, is that too much testosterone causes blood clots. Again, it has been observed that high levels of estradiol are correlated with more blood clots and strokes, including those strokes which are caused by blood clots.

Conclusion

Any study that shows any adverse effects with regards to testosterone without ensuring that estradiol levels and red blood cell counts are in the safe range should automatically be discounted.

Tajik translation of this page is available here

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Contact info: ed@math.uchicago.edu