#112 Testosterone supplementation in men: Let’s pause for a moment
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- 58 healthy men (age ≥60) followed 23 months.1
- No difference in quality of life, physical performance, or adverse effects.
- 237 men (age 60-80) followed six months.2
- No consistent difference in cognitive function, strength, quality of life, or adverse effects.
- 209 men (age ≥65) with mobility issues (and higher cardiovascular risk) followed for six months.3
- Improved leg and chest press strength, stair climb power with load by ~7%.
- Stopped early for harm: All cardiovascular outcomes (hypertension to cardiovascular death), 22% testosterone vs. 5%.
- Handgrip strength [standard mean difference (SMD)=0.30]4 and total body strength (SMD=0.54).5
- Morning erections (SMD=0.65), libido (SMD=1.31), and sexual satisfaction (SMD≈1.2).6,7
- Cardiovascular disease (Odds ratio 1.61)8,9 and prostate complications [from increase symptom score to cancer] (Odds ratio 1.78).10
- Enthusiasm for any positive findings is tempered due to inconsistent results, small sample sizes, poor method description, lack of validated/useful endpoints, funding bias, and multiple outcome reporting.
- Frequently do not specify if included symptomatic hypogonadism.
- Some suggest 0.8 SMD represents a large effect6 but this is estimation.
- FDA and the European Medicines Agency are reviewing testosterone safety due to cohort studies linking testosterone to cardiovascular events.11-14
- “Normal” range of total AM testosterone 10-35 nmol/L.15
- Varies with different labs, circadian rhythms, age, comorbidities, medications, and episodic secretion.
- ~30% of mildly hypogonadal levels will normalize on retesting.15,16
- Guidelines recommend testing testosterone levels and subsequent treatment only if symptomatic.16,17