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