Most people want simple, easy answers: is testosterone therapy “good” or “bad”? Is it safe or not? But the reality is not black and white. Here are three truths about testosterone science:

1. Doing the opposite of what harmed someone will not necessarily treat him.

Cycling CoupleFor instance, perhaps a poor diet and lack of exercise causes a man to develop diabetes, obesity, low testosterone levels and other hormonal/metabolic problems. He might benefit from an improved diet and more exercise, which could cause beneficial changes to his hormonal profile. However, he may not be able to undo all the damage to his body, had he never indulged in a bad diet and sedentary lifestyle from the start.

2. Researchers have a checkered history of understanding chronic metabolic health issues.

Despite decades of intense study — and billions of dollars of effort expended — the research establishment is not much closer to solving major metabolic puzzles, like cancer, than it was 40 years ago. Meanwhile, once-relatively-rare diseases, like obesity and diabetes, have become epidemic in the United States. Some estimates say that two-thirds of all Americans are now overweight. Yet the research establishment has made little progress — it has barely been able to slow the acceleration of these epidemics.

Heart Disease AwarenessIn 1990s, researchers cut short a famous, massive effort to use hormone replacement therapy to help older women. It turned out that the hormone therapy increased women’s risk of cancer and mortality, as opposed to decreasing it. Here is a quote from a 2007 New York Times article about this infamous medical experiment:

“By the mid-1990s, the American Heart Association, the American College of Physicians and the American College of Obstetricians and Gynecologists had all concluded that the beneficial effects of H.R.T. were sufficiently well established that it could be recommended to older women as a means of warding off heart disease and osteoporosis. By 2001, 15 million women were filling H.R.T. prescriptions annually; [many] were older women, taking the drug solely with the expectation that it would allow them to lead a longer and healthier life. A year later, the tide would turn. In the summer of 2002, estrogen therapy was exposed as a hazard to health rather than a benefit, and its story became what Jerry Avorn, a Harvard epidemiologist, has called the “estrogen debacle” and a “case study waiting to be written” on the elusive search for truth in medicine.”

This is not to say that science cannot provide powerful insight into what causes (or potentially might cure) low testosterone and the diseases/symptoms associated with it. However, it does suggest that caution and skepticism should rule the day.

3. Not all men respond to testosterone therapies the same way.

As Andrew Sullivan’s journey shows, some men who get testosterone replacements claim to feel immediate and palpable benefits. Yet the study on older, chronically sick veterans suggests that, in certain cohorts, the therapy can cause way more harm than good.

Happy ManNot only might different people react differently to the therapy, but also the therapy could have different effects on the same man over time. Testosterone replacement could be benign in an otherwise healthy man in his 40s and 50s. However, if that man develops a chronic illness or metabolic problems or gets older, that same therapy could prove to be dangerous. It might, for instance, provoke a fatal coronary event.

Medical problems caused by testosterone therapy might not appear immediately. A single, normal dose of the hormone would be unlikely to suddenly clog the arteries of an otherwise healthy man and kill him. The damage caused by inappropriate hormonal therapies tends to accumulate over time, and evidence of problems may be spare… until a health catastrophe hits.

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