Yesterday, I briefly discussed the statistics of a
retrospective national cohort study published in JAMA in which the
authors linked testosterone use to increase risk of heart attack, stroke & death. To be clear, the statistics do not support their conclusion, at least not on a statistically significant level. In other words, the outcome was purely chance and could have resulted in the opposite conclusion 95% of the time if this study was repeated enough. How do I know this? The
Confidence Interval crossed or included zero.
So let's be clear. There is no such thing as a free lunch. All medications (and dietary supplements) have risks, whether known or unknown. Even natural, pure, organic herbs have side effects. The question then is whether the desired potential benefit exceeds the risk of side effects. I'm going to assume you've seen all the commercials, whether on TV or print, or heard them on radio asking "Do you have low T?" But as w/all advertisements for medical therapies, there is a hastily read disclaimer or one that is flashed onscreen for just a few brief moments in font size too small for easy research, which supposedly describes all known side effects to you.
With that said, part of me is not surprised by the findings of this study. Why? Because I counsel each of my patients who are considering testosterone therapy as to these exact outcomes, among others.
Excess testosterone can increase blood pressure (not an issue in this study),
lower HDL (good) cholesterol (not measured, at least, not reported, in this study), and
increase red blood cell mass thereby increasing viscosity and one's risk for developing clots. As you know, clots in the heart are referred to as heart attack while those that occur in the brain are called strokes. So yes, I counsel all my patients repeatedly, before & during their time on T, about a possibly greater risk for heart attack, stroke & death.
But how I can I be so blase about all this? Because I monitor my patients' lab results at least every 6 months and check their blood pressure regularly. Excess blood is siphoned off to be donated to hungry vampire families. T regimen is adjusted to minimize highs & lows, of which the former is responsible for the increase in blood pressure & red blood cell mass. In fact, large monthly injections of T are notorious for these metabolic side effects while smaller doses of more frequent injections are not. Daily applications of creams, gels, patches, etc are least likely to cause this issue.
And to be as complete as possible, I also warn my patients about being rendered infertile as well as developing noticeable testicular atrophy. That's in addition to the risk for 'roid rage (akin to road rage), agitation, aggravation, impatience, intolerance, etc. Then let's not forget hair loss, oily skin (even acne), prostate enlargement (no new onset of cancer tho), male breast enlargement (gynecomastia). But even these risks can be mitigated by close monitoring & regimen adjustment. So at most, these study really demonstrates a link between testosterone therapy and bad outcomes when said therapy is not monitored closely: average number of lab measurements over the 3yrs was just 3.3, not nearly enough to mitigate risk.
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