Testosterone Treatment Lowers Mortality in Hypogonadal Men

I like to think that I can stay ahead of the curve by reading stuff published online prior to print months later but try as I might, I don't get to all the good stuff.  Consider me, then, a blind squirrel who occasionally stumbles upon a nut (like last night's advance screening of Ridley Scott's Prometheus).  In this case, the nut is a cohort analysis published online back in April but now finally available in print in this month's issue of the Journal of Clinical Endocrinology & Metabolism in which the authors concluded that testosterone treatment of hypogonadal men was associated with decreased all-cause mortality compared to those men w/low testosterone who did not receive testosterone.

The authors followed for an average duration of 40mo 1031 male veterans, average age 62yo w/average body mass index (BMI) 32.0kg/m2, and average Total Testosterone (TT) 181ng/dL, without any prior history of prostate cancer.  Those who received testosterone (n=398) were followed for 42.8mo vs 38.0mo in those who chose not (n=633), were slightly younger at 60.9yo vs 62.8yo, had higher BMI of 33.0kg/m2 vs 31.4kg/m2, and had lower TT at 160ng/dL vs 193ng/dL.  Overall, these were very sick veterans w/6+ chronic medical conditions, unlike the typical younger guy asking for anabolic steroids or performance enhancing drugs.

The majority of the recipients were prescribed injectable testosterone (88.6%) although a small fraction received patch (9.1%) or gel (2.3%) forms.  What's interesting is that median duration of treatment was 16.6mo w/average duration of 20.2mo during the average 3+yrs of follow up.

While the editorialist rightly pointed out several shortcomings of the study, I find it impressive to think that less than 2yrs of testosterone was associated w/39% relative risk reduction in all-cause mortality.  Unfortunately, the authors were unable to determine the actual cause of death from the original databases.  Furthermore, they were unable to ascertain why testosterone levels were checked in the first place, nor what level of Total Testosterone was achieved in order to obtain such results.  

So this isn't a randomized controlled trial of testosterone vs placebo, which would demonstrate cause & effect, but just an observational cohort study, which supports hypothesis development.  Still this is another step towards treating hypogonadal men to decrease mortality.  Do I hear any volunteers for a randomized controlled trial?

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