Does Prescribing Testosterone to Older Men with Low T do any Good?

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October 9, 2014

Dr. Sergei Romashkan, a doctor who works at the National Institute on Aging and oversees that agency’s clinical trials, once famously opined: “The problem is that we don’t have any evidence that prescribing testosterone to older men with relatively low testosterone levels does any good.”

Meanwhile, the risks of such therapies can be pretty scary. For instance, as the WebMD article notes: “testosterone therapy can raise a man’s blood cell count. This can lead to thickening of the blood, which may make stroke and clotting more likely.”

Other side effects that are less common can include:

Sleep apnea;
Liver damage;
Kidney problems;
Acne;
Breast enlargement;
Dozens of other rare but significant conditions.

Even Dr. Eisenberg, who consults for drugmakers to produce Testosterone Replacement Therapy, noted in the WebMD article that scientists do not know a lot about the long-term safety of TRT. For instance, some evidence suggests that the therapy may lead to increases in prostate cancer, although the science in that area is thin.

Meanwhile, many men experience immediate and psychologically rewarding benefits, at least over the short term. As Dr. Morgentaler notes: “this is one of the very few areas of medicine where a male patient will come to you and say, ‘you made me feel like myself again.’ I hear from their wives, too, who say ‘you gave me my husband back.'”

It is wonderful that such a therapy can have such positive effects for people like Andrew Sullivan. However, just because a therapy helps (or at least seems to help) in the short term does not mean that it is not also doing long-term damage… like increasing the risk for cardiovascular disease, stroke and clotting.