Wednesday, 17 December 2014

Testosterone - should you be taking it?

There's an apocryphal story in medicine that goes like this:

An eminent professor concluded his speech to the graduating class with the following comment:

"Ladies and Gentlemen, 50% of everything we have taught you about medicine is wrong, the trouble is, at the moment, we don't know which 50%. Your job is to work it out"

In medicine we have interesting, and contradictory, positions with respect to hormone replacement. 

In women we recognise a condition called menopause, which happens to women in their 40s and 50s when the levels of the hormones oestrogen and progesterone fall rapidly and the menstrual cycle becomes first erratic, then stops altogether. 

We know that many women get symptomatic relief from symptoms of menopause like hot flushes, night sweats, and mood swings if we give them small doses of these missing hormones.

In men the situation is a little different. Testosterone is the primary male hormone, and levels start falling more or less immediately after sexual maturity is reached in the early 20s.

It has taken medical science a long time to get it's head around thinking that males also experience a form or menopause, which some people call Andropause. Perhaps it's because the decline is so slow, or it's because there is no obvious "change of life", other than the pervasive male middle aged spread?

We are now at the point where it has been found that men with Testosterone levels in the lowest 25% actually have the highest levels of cardiovascular mortality - ie die from strokes and heart attacks 

Furthermore supplemental testosterone is safe for cardiovascular health, according to research presented at a meeting of the American Heart Association in Chicago.

It shows men on supplementation have reduced overall rates of major adverse cardiac events at one and three years after their initial low levels of testosterone were measured compared with men with persistently low levels of testosterone.

The study results coincide with an FDA evaluation of the safety of testosterone supplementation and whether it is a risk to the health of older men.

The researchers say it provides reassurance to doctors who can use testosterone with less concern about its effect on patients' heart health.

"With this study we are getting closer to defining the true associations between testosterone treatment and cardiovascular risks or benefits," says study leader Jeffrey Anderson, a cardiologist at the Intermountain Medical Center Heart Institute.

So if you're a man, battling middle aged spread and loss of libido perhaps you should talk to your doctor about having you testosterone level measured, and if it's low, considering supplementation?


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