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Durban - Hormone replacement therapy, however outdated the phrase may be, is widely associated with women and low oestrogen levels.
Simply put, the same concept exists for men who are low on the male hormone, testosterone.
Testosterone is important for the development of reproductive organs as well as physical characteristics, such as increased muscle strength and hair growth.
Testosterone deficiency (TD), which may be detected in the blood, is often underdiagnosed and undertreated. Symptoms include weight gain, fatigue, decreased muscle mass and strength, low self-worth and low libido. It’s the latter that has made concerned wives the key role players in diagnosis, as men do not traditionally seek out medical help for these symptoms.
Professor Hugh Jones, an expert in testosterone, who was in Durban recently, explained why seeking treatment was important.
Jones conducts clinical and laboratory research into the role of testosterone and the treatment of type two diabetes and cardiovascular disease as well as co-chairs the testosterone and metabolic disorders group as part of the International Consultation on Men’s Health and Infertility.
He says a deficiency in testosterone is a biomarker for life-threatening illnesses such as cardiovascular disease and life-altering illnesses such as diabetes.
“There are many other causes for heart disease and diabetes, but in some cases TD is one of them, which means that testosterone therapy is a potential treatment. Proper investigation and early intervention can therefore be life-saving.”
Jones says this doesn’t mean that every man should be taking testosterone.
“Diagnosis is critical and morning blood tests – preferably two of these to be certain – are likely to determine whether or not a man has TD. Just as important is the amount of testosterone received. Treatment, based on clinical trials, should be to return testosterone levels to what is normal for that individual.”
He says a number of clinical trials failed due to a lack of proper diagnosis, low or excess levels of testosterone being administered and studies not being well monitored.
He believes this is why the concept has not been well received by everyone.
“We know that TD is associated with numerous health conditions, including type two diabetes, obesity and metabolic syndrome (a cluster of cardiovascular risk factors, including abdominal obesity, high cholesterol, high blood pressure and high blood sugar levels).
“Under the correct conditions, testosterone can be used to avoid serious ailments.
“Studies conducted in the last 10 years indicate that low testosterone levels are associated with an increase in the risk for developing type two diabetes.
“In these cases testosterone replacement therapy (TRT) has shown to be beneficial.”
He says there are also studies that suggest TRT improves certain cardiovascular risk factors, which include insulin resistance, cholesterol, body fat composition and sexual function in men with type two diabetes.
“The exact mechanism by which testosterone reduces insulin resistance is uncertain. There is considerable evidence linking abdominal obesity to insulin resistance.
“Testosterone therapy results in a significant reduction in waist circumference and waist/hip ratio – which is an indicator of (visceral) abdominal fat. The belief is, therefore, that testosterone reduces insulin resistance (and therefore type 2 diabetes) by reducing abdominal fat.”
Jones says having liposuction will not help as it’s the enzyme around the gut that is the culprit.
And that taking Viagra is not the same as taking testosterone.
This treatment is also not suitable for men with prostate cancer.
Testosterone may be found in gel, cream or injection form.
Many factors go into the selection of therapy; including the pattern of testosterone levels produced, side effects, convenience and ease of administration.
Differing doses and the duration of the treatment are also key.
Doubt over safety of hormonal therapy
Older men treated with testosterone run a higher risk of death, heart attacks and strokes, according to a recent study suggesting the hormone therapy may need to be reconsidered.
The researchers followed more than 8 700 men who had low levels of the hormone, of whom 1 223 took a testosterone supplement for a median period of about two years.
Three years later, nearly one in five of the men who had not taken a supplement (presumably a placebo) had suffered a heart attack or stroke, or had died. However, one in four of the men who had been treated with testosterone, experienced an overall increased risk of nearly 30 percent.
The increased risk of catastrophic events was especially notable, said researcher Anne Cappola of the University of Pennsylvania, because “the men who were taking testosterone in this study were slightly healthier to begin with”.
The men receiving testosterone also tended to be younger – they had an average age of 61, compared to an average age of 64 for the untreated men.
“These findings raise concerns about the potential safety of testosterone therapy,” the authors, including lead researcher Rebecca Vigan of the University of Texas, wrote in the study. Further studies were needed “to properly characterise the potential risks”, especially among older men, or men with other risk factors.
The number of annual prescriptions for testosterone therapy increased fivefold between 2000 and 2011 in the US, reaching 5.3 million prescriptions, the authors emphasised.
The therapy is recommended for those with below-normal levels of the hormone whose symptoms include diminished sex drive, low energy and worsening memory.
In addition to improving sex drive and bone density, the hormone has been shown to increase muscle mass and strength.
It is not clear from this research whether the increased risk of death, heart attack and stroke existed among patients prescribed testosterone therapy for “low T syndrome” or younger men taking it for physical enhancement, Cappola said.
An ongoing randomised trial of more than 800 men over the age of 65 receiving testosterone or a placebo could help provide guidance for older men considering testosterone therapy.
Until more is known, however, “prescribers and patients should be wary”, she said. – Sapa-AFP