OK, I admit it. I don't always keep up with the literature, try as I might. In this case, I missed a nice
review of testosterone deficiency published last July in the American Journal of Medicine. I stumbled upon this because I happened upon a
letter to the editor regarding said review in which the letter's authors likened the use of testosterone to that of estrogen prior to the Women's Health Initiative. The
review's authors came back with what I thought was a reasoned reply.
Understandably, there continues to be controversy among physicians regarding the use of testosterone to treat deficiency states, especially when we haven't come to grips with correlating various laboratory reference rages with clinical symptoms. This doesn't even begin to consider what to do with the patient with low normal results and clinical symptoms. And now these avant garde physicians on the bleeding edge of the cutting edge of medicine are proposing that we consider testosterone supplementation for those patients with metabolic syndrome!
Let me reiterate that we don't have randomized controlled trials demonstrating long term efficacy and/or safety with testosterone supplementation. However, we do have many observational studies demonstrating an association of testosterone deficiency with all-cause mortality and cardiovascular disease. Furthermore, there is some early evidence that testosterone replacement may reverse early diabetes or at least aid in its control. Certainly, many studies have demonstrated an improvement in quality of life.
While I don't recommend that we all jump on the bandwagon and put testosterone into the water supply, I also think that waiting until results from randomized controlled trials are available will prevent many clinically symptomatic patients from enjoying their golden years. So let's try to find the proper balance to
Hippocrates' words: "to cure sometimes, relieve often, and comfort always."
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