June 30, 2010
Testosterone Gel Increases Heart Risks

Old guys with existing chronic diseases such as diabetes and heart disease had more cardiovascular events when receiving testosterone via a gel.

A clinical trial of testosterone treatment in older men, reported June 30 online in the New England Journal of Medicine, has found a higher rate of adverse cardiovascular events, such as heart attacks and elevated blood pressure, in a group of older men receiving testosterone gel compared to those receiving placebo. Due to these events, the treatment phase of the trial was stopped. The study was supported by a grant to Shalender Bhasin, M.D., at Boston Medical Center from the National Institute on Aging (NIA), part of the National Institutes of Health.

Is it possible to use hormone supplementation to achieve a net health benefit? The answer is not clear. These men had an average age of 74 and existing health problems. Does testosterone cause problems with slightly younger and healthier men?

Decreased muscle strength may contribute to difficulties in mobility, such as in walking or climbing stairs, which can limit older personsí independence. Testosterone treatment has been shown to improve muscle strength in some older men, but it is not yet known whether it would reduce mobility limitations in older men with low testosterone levels. The TOM (Testosterone in Older Men) Trial was designed to address this question. It was a randomized, double-blind, placebo-controlled clinical trial of the effects of six months of testosterone gel treatment on strength and ability to walk and climb stairs in 209 older men with low testosterone levels and mobility limitations. The testosterone gel used in this study was administered to the skin daily. The 209 men in the trial had an average age of 74 and high rates of chronic diseases such as diabetes and cardiovascular disease.

It is possible that at a younger age testosterone could deliver a net benefit. But this is speculation on my part. The problem is that as we age lots of mechanisms have gone so awry that stimulating them just causes them to go wrong faster. Though another recent study found that ovary transplants improve the health of aged female mice. Those ovaries pump out a lot of hormones and yet they deliver a net benefit. Maybe the reason the transplants deliver a net benefit is that the ovaries excrete multiple kinds of hormones and with hormone release patterns optimized to improve health. Internal organs have complex regulatory mechanisms. Whereas testosterone gels are not released in ways that precisely mimic what the brain will do.

Share |      Randall Parker, 2010 June 30 11:31 PM  Aging Treatment Studies


Comments
CS said at July 2, 2010 4:02 PM:

"The authors caution that the ability to draw broader conclusions about the safety of testosterone therapy based on these findings is constrained by several factors, including this studyís small size and the fact that the studyís population was older and had higher rates of chronic diseases and mobility limitation than individuals in most other studies.

In addition, the trialís eligibility criteria excluded men with severely low testosterone levels, limiting the ability to make inferences about safety in this population. The authors also note that the testosterone doses and serum levels in this trial may be higher than those usually used in clinical practice and in some previous clinical trials.

NIA is funding six other trials studying the effects of testosterone. All of the principal investigators of those trials and their DSMBs and Safety Officers have been informed of the findings in the TOM Trial. After reviewing these findings, and other evidence relating to safety of testosterone treatment, the DSMBs and Safety Officers recommended continuation of the trials, with provision of additional information to participants and additional safety precautions. NIA has reviewed these recommendations and concurs with them."

Sigh.

billcat said at July 3, 2010 4:01 AM:

I think you very well could be onto something in your last paragraph. Like the ovaries transplant shows, the gonads produce more hormones and chemicals that are beneficial to the health in ways we don't fully understand yet.
But what happens when someone is put on testogel or any other TRT is that the testicles shut down completely, and thereby stop producing any hormones whatsoever.
That's why testosterone therapy should be supplemented with hCG injections to keep the testes up and running in the background.

Besides, a lot of guys do not like testogel or repond well to it.
I've read several reports where testosterone levels actually decreased while on testogel. This seems to be due to individual differences in absorption rates. In addition testosterone absorbed through the skin will aromatize a lot more than through others means of administration. So the net effect will be some extra testosterone, lots more estrogen (which will kill the bodys own testosterone production) giving a net not-so-good therapy.

So:
Administering testosterone through the skin is not an ideal way for a lot of people. (Stick to shots, then it's in there)
Skin administration will give more estrogen than other means of administration. Excess estrogen in older men is associated with numerous health problems, cardiovascular among them.
Previous history of thyroid problems seems to influence skin testosterone absorption negatively, and these were sick guys.

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