We have been discussing testosterone and, in particular, the adverse health consequences associated with extreme doses of anabolic-androgenic steroids. Typically, high doses of testosterone and its ilk tend to be consumed by those who need it the least – that is, young men who already possess optimal levels of testosterone. Not surprisingly, this form of testosterone use is not medically advisable.
What may be justified, however, is the therapeutic use of testosterone among some men who are deemed hypogonadal.
Hypogonadal. Or low production of gonadal hormones. Hypo, as in below, underneath, or deficient. Gonadal, as in testicles — if you are a man.
There are a number of disease processes, as well as genetic and congenital factors, that may cause or contribute to hypogonadism. For some of these conditions, testosterone replacement therapy represents an important protective measure against osteoporosis (frail bones) and may assist in the development or maintenance of masculine characteristics. Use of testosterone replacement therapy under these circumstances is not controversial.
Testosterone replacement therapy, however, is controversial when it is used among otherwise healthy men whose only crime is that they are no longer young. This population — healthy old codgers — have been targeted directly by pharmaceutical companies and some medical practitioners. These men are not normally suffering from hypogonadism due to any sinister dysfunction or disease process. But they are aging and they are concerned about a loss of sexual interest and their ability to achieve and maintain erections.
Should we care if a septuagenarian wishes to experiment with testosterone replacement therapy in an effort to regain lost youthful vigor?
There is no strong evidence that supports the use of testosterone replacement therapy. Equally, there is no strong evidence that does not support the use of testosterone therapy. There is no strong evidence either way. Period. Or as Bradley Anawalt states in his editorial in the Journal of Clinical Endocrinology and Metabolism: “We can scarcely know less about the long-term effects of testosterone therapy on clinically meaningful outcomes in men.”
So, let’s see. Powerful hormones with, as of yet, unknown benefit and unknown risk applied liberally by healthy men seeking memories of youth.
But I am sure it will all turn out fine.
- Anawalt, B. D. (2010). Guidelines for testosterone therapy for men: How to avoid a mad (t)ea party by getting personal. The Journal of Clinical Endocrinology & Metabolism, 95, 2614-2617.
- Bhasin, S., Cunningham, G. R., Hayes, F. J., Matsumoto, A. M., Snyder, P. J, Swerdloff, R. S., & Montori, V. M. (2010). Testosterone therapy in men with androgen deficiency syndromes: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 95, 2536-2559.
- Fernández-Balsells, M. M., Murad, M. H., Lane, M., Lampropulos, J. F., Albuquerque, F., Mullan, R. J., . . . Montori, V. M. (2010). Adverse effects of testosterone therapy in adult men: A systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism, 95, 2560-2575.