June 15, 2009
Testosterone Cuts Incidence Of Metabolic Syndrome
Should older men take testosterone as a replacement therapy for declining natural testosterone levels?
In middle-aged and older men with low testosterone levels, long-term testosterone replacement therapy greatly improves their fatty liver disease and their risk factors for cardiovascular disease and diabetes, a new study found. The results were presented at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.
Testosterone deficiency, which becomes more common with age, is linked not only to decreased libido but also to a number of medical problems. These include the metabolic syndrome—a cluster of metabolic risk factors that increase the chances of developing heart disease, stroke and type 2 diabetes. Nonalcoholic fatty liver disease, also called a fatty liver, commonly co-occurs with the metabolic syndrome and may aggravate the metabolic problems. To receive a diagnosis of the metabolic syndrome, patients must have three of the following five risk factors: abdominal obesity (a large waist line), low HDL (“good”) cholesterol, high triglycerides (fats in the blood), high blood pressure and high blood sugar.
“Physicians often are reluctant to prescribe testosterone for conditions not related to sexual function,” said the study’s co-author, Farid Saad, PhD, of Berlin-headquartered Bayer Schering Pharma. “However, our study shows that testosterone has a much wider therapeutic role than just for improving sexual desire and erectile function.”
The study included 122 testosterone-deficient men, ages 36 to 69 years (mean age: 59.5). Results showed that restoring testosterone to normal levels led to major and progressive improvements in many features of the metabolic syndrome over the 2 years of treatment. Specifically, the men’s weight, waist line and body mass index (a measure of body fat) continued to decline over the full study period. The other metabolic risk factors also significantly improved during the first year of testosterone treatment. Of the 47 men who met the criteria for a diagnosis of the metabolic syndrome at the beginning of the study, 36 (77 percent) no longer had the diagnosis after 2 years of treatment, the authors reported.
Furthermore, liver function significantly improved during the first 12 to 18 months of therapy and stabilized for the remainder of the study period. Treatment also greatly decreased blood levels of C-reactive protein, a measure of inflammation that is linked to increased risk of cardiovascular disease.
“We conclude that testosterone therapy in men with testosterone deficiency can largely improve or even remedy the metabolic syndrome, which will most likely decrease their risk of diabetes and cardiovascular disease,” Saad said.
The various symptoms of metabolic syndrome (including bad blood lipids profile, reduced insulin sensitivity, more belly fat, and higher levels of C-reactive protein) set you up for all sorts of problems such as sleep apnea (where people wake up constantly while sleeping due to inability to breathe well while sleeping) and heart disease. A treatment that reduces the symptoms of metabolic syndrome might increase longevity. Though testosterone treatment might put men at higher risk of other diseases. So is there a net benefit from testosterone therapy in older men? The answer is not clear and might depend on whether one has metabolic syndrome. Those who have metabolic syndrome will probably derive a bigger benefit from testosterone therapy.
What I wonder: Is testosterone therapy safer if taken with a 5-alpha-reductase inhibitor drug such as dutasteride or finasteride? These 5-alpha-reductase inhibitors block the conversion of testosterone into dihydrotestosterone (DHT) and are used to stop hair loss and to treat benign prostate hyperplasia (enlarged prostate). A boost of testosterone combined with a lowering of dihydrotestosterone might deliver more benefits with fewer harmful side effects. For example, risk of prostate cancer might be lowered. I'm not sure on that point. If anyone has insights on this please pipe up in the comments.
A boost of testosterone combined with a lowering of dihydrotestosterone might deliver more benefits with fewer harmful side effects.
A decrease in libido is a side effect of alpha-reductase inhibiting drugs such as propecia (finasteride), that lower DHT. Though Merck claims that libido returns in a few weeks, for some (perhaps many) people, libido never returns until cessation of the drug. DHT has some important functions, though it can enlarge the prostate.
Another danger in testosterone supplementation is its conversion to estrogen, after testosterone levels build up. Body builders are at particular risk for this condition, as they inject massive doses of synthetic testosterone. Thus they usually take arimidex or novadex to block aromatase from converting testosterone to estrogen.
Doubtlessly, testosterone has many important benefits, but testosterone supplementation, like growth hormone supplemention, needs to be monitored with care.
So, is it metabolic syndrome if you've got the belly fat and bad cholesterol ratio, but your blood pressure is in the normal range only because it started out abnormally low? (80/54 when I was in my 20s.) My doctor seems to think so, but there's this little problem: My PSA is 5.2, so it's off to the urologist before he can prescribe the testosterone.
Recent studies show that testosterone replacement therapy does not increase risk of prostate cancer. (http://www.hno.harvard.edu/gazette/2004/02.05/10-testosterone.html) In fact the same studies showed that patients with low testosterone levels actually developed more aggressive prostate cancer.
Also, traditional testosterone replacement therapy (non-supraphysiologic) should not have any risk of side effects from conversion to estrogen. We, as physicians, want to get your testosterone levels near the mid-range of normal, not excessive. As with any therapy or medication, monitoring needs to be done. Traditionally, testosterone replacement therapy monitoring includes regular lipid, hepatic enzyme , PSA and digital prostate exams.
"In fact the same studies showed that patients with low testosterone levels actually developed more aggressive prostate cancer."
That makes sense; Prostate cancer is normally dependent on testosterone, and treated by blocking it; If you get prostate cancer without testosterone, it's going to be a hard to treat cancer, because it won't respond to the normal treatment with testosterone blockers.
"Also, traditional testosterone replacement therapy (non-supraphysiologic) should not have any risk of side effects from conversion to estrogen."
I think you're missing a point here: Metabolic syndrome involves a lot of fat being present, and fat tissue does that conversion. So conversion to estrogen is excessively high in such people. That's why men who are grossly overweight, and lose it, frequently find that they've got breasts. It's not because they had supraphysiologic testosterone levels.
Might need aromatase blockers until a normal level of fat is achieved for that reason.
Testosterone therapy is a wonder and should be widespread in society. The fact that TRT is not common speaks to the corruption of the AMA and the overwhelming feminization of our society. So many doctors are complete nimrods on the subject and are afraid to investigate the therapy because of the negative press and the treatment of testosterone as a controlled substance. The result is the needless suffering of millions of men. It is well-known, by many patients and doctors, that TRT can greatly enhance a patient's quality of life on day one of treatment. Many cases of depression are also alleviated through TRT.
People can harp about side affects, but harping only serves to limit the free will and voluntary choices of men who are actually suffering. I use 100mg of t-cypionate every 7 days, HCG every 3 days and 1 DIM every day and the results are magic. I would think a great many men would benefit from treatment around ages 30-35. Unfortunately, physicians want to treat male hormones as if they are evil and most men will need to wait until 60 before the TRT option is presented to them. I remember the fantastic stupidity of not fewer than 7 doctors who told me that TRT was dangerous. They knew nothing about the subject, only what they heard on CNN and in the popular press. In a just world, taking cues from CNN would be cause for revocation of licensure.
It's the whole doping thing: Our medicine is terribly warped by the desire to keep professional sports 'fair', regardless of the impact on people who aren't involved in those sports. That, and the war on drugs; Rational medical judgment goes out the window for any drug that's considered to have 'abuse' potential, whether for 'doping' or recreation.
I've just had the 'dread' exam,
It's left me in a fog.
The Doc, he called it digital;
It felt like analog.
Brett is correct in that adipose tissue leads to increased aromatization of testoserone into estradiol which leads to a separate question for me. In most of these men, they probably suffered from secondary hypogonadism rather than primary. If that's the case, would it not be better to use clomiphene citrate to reduce the inhibition of estrogen on the hypothalamus, thereby promoting normal testosterone production by the testes? The use of exogenous testosterone will also lead to suppression of normal production making the therapy a permanent issue.
Avoid the testosterone therapy and use natural testosterone boosters, such as Tongkat Ali, along with estrogen blockers such as chrysin. For most guys, that will do the trick. I agree with the other comments, avoid finasteride like the plague.
I'm of the opinion that testosterone therapy for younger men is the easy way out. Keep body fat levels in check, avoid estrogenic foods, chemicals, prescription medications, and excess alcohol. Exercise with high intensity in order to maintain lean body mass, and boost growth hormone, and low T won't be a problem.
When I hit 65 or so, I may jump to the other side, but for now, this is working for me.
I take finasteride to stop hair loss. There have been absolutely no side effects, my sex drive and performance remains ideal.
There are risks and benefits to any hormone replacement therapy be it testosterone for men or estrogen for woman. Gynecologists give women estrogen supplements from the moment that menopause is suspected and no one thinks anything more about it.
"The hormonal treatment of menopause has gone through a revolution in just the last ten or fifteen years. It wasn’t that long ago that estrogen—most often sold under the trade name Premarin—was used almost exclusively in the first few years after menopause to quiet down the mood swings and hot flashes. However, while estrogen is unarguably helpful in achieving those goals, we now know that its far more important long-term effects are to decrease dramatically the risks of heart disease and osteoporosis while improving mood and decreasing depression. There is also strong new evidence that estrogen replacement decreases the incidence of Alzheimer’s disease. For almost all women, estrogen should be taken lifelong after the onset of menopause." -Alan Bonsteel MD
Andropause is a documented and recognized condition in the medical community, just like menopause. The benefits from testosterone supplements are as myriad as estrogen supplements and the benefits far outweigh the risks. But try suggesting to your primary physician that almost all men should take testosterone supplements lifelong after the onset of andropause.
It's clearly a double standard.
You'd be better off reducing estrogen via an inhibitor like Arimidex or Aromasin than reducing DHT. DHT carries most of the beneficial effects of testosterone replacement which you'd be robbing yourself if using Finasteride. Excess estrogen is the real risk factor.
I'm all for testosterone therapy, but before you reach for that 5-alpha-reductase inhibitor, you might want to look at the experiences of thousands of people who have tried it.
Check out propeciasideeffects.com
Turns out your body needs all that pesky DHT, and when you suppress it you can knock your HPTA off balance. Some guys who took propecia for hair loss are still unable to get wood a year after they come off. Lots of pending lawsuits, changing of packaging in some countries to reflect the risks is currently underway. Thousands of poor guys on that forum with a lot of problems - it's a real shame.
Keeping the prostate and PSA levels in general in check makes sense, but 'bald or impotent' is a bad choice to have to make.
I believe with what some other people mentioned about perhaps trying to increase your testosterone through supplementation or various replacement therapies if you're older and clearly need it. This shouldn't be a "quick fix" for younger males who are trying to build muscle and/or burn fat. Taking testosterone to try and cut corners is not a good idea, however some older individuals have apparently improved their health a great deal with testosterone therapies.