A recent Veteran’s Administration study published in JAMA, the Journal of the American Medical Association, has received much media attention, raising fears regarding the use of testosterone replacement in aging men. The study had multiple flaws that limit its usefulness. Some of these flaws include:
The results of this study are contrary to the vast majority of studies supporting the benefits of testosterone replacement. Other studies using better methodology have concluded that:
As Cenegenics physicians, we strive to give you the latest information regarding our therapies. An example is putting studies like this into perspective.
Not only do we want the best care for our patients, as patients ourselves, we want to be sure we are doing the right thing for our own health. You can count on Cenegenics for accurate, unbiased information. Our continued mission is to provide our elite patients with the best medical care possible.
So what’s the take home message?
An overwhelming amount of medical literature supports the positive benefits of testosterone replacement, even in patients with coronary disease and heart failure.
While the study raises the possibility that a subset of elderly patients with significant cardiovascular disease could conceivably have an increased risk of events, this risk could be minimized or eliminated by the use of 81mg of aspirin.
Testosterone replacement should be given and followed by a physician experienced in its use.
Testosterone replacement should be accompanied by lifestyle modifications to achieve maximum benefit.
Testosterone’s effects are body wide. Because about 30% of testosterone is bound to sex hormone binding globulin (SHBG), it is not biologically available. It is the 1% to 2% of free testosterone (free T) that is physiologically active. Its presence is (or lack thereof) manifest in multiple organ systems, with testosterone associated with retention of desirable values of actuarial disease risk and with well-maintained body composition. The impact of falling testosterone levels upon many of these parameters is examined as part of this presentation.
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