Testosterone: Getting to the Heart of the Matter, Part 3

Two days ago, I pointed some statistical issues with the recent national cohort study published in JAMA.  Yesterday, I pointed out the known complications & side effects of (poorly monitored) testosterone therapy.  Today, I thought I'd close out the series by looking at the Endocrine Society's June 2010 Clinical Practice Guideline regarding the use of testosterone in older men, more specifically, areas which weren't addressed (adequately) by the authors.

For instance, while equal percentages of participants had obstructive sleep apnea (Table 1), there's no mention of any attempt to screen for those previously undiagnosed or untreated.  Furthermore, the Endocrine Society's Clinical Practice Guidelines note that testosterone therapy may worsen untreated obstructive sleep apnea.

With regard to monitoring, the Endocrine Society recommends evaluating the patient 3-6mo after treatment initiation followed by annual evaluation.  However, I find that to be a long time between contact & objective measurement.  After all, how easily do you fall off the nutrition & physical activity bandwagon.  Better to be reminded more often to stay on target as opposed to finding out too late.

And while there doesn't appear to be any difference in blood pressures in either group, there's no mention of hemoglobin or hematocrit, much less HDL cholesterol, all of which, when abnormal, can increase one's risk for prothrombotic events such as heart attack or stroke.  This is mentioned several times in the Clinical Practice Guidelines.

Bottom line, get frequent follow up so that you can enjoy the benefits of testosterone for years to come.

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