TESTOSTERONE AND MEN’S HEALTH 

 

Low Testosterone a Killer!

August 28, 2006
Chris Rao M.D.

Men with Low Testosterone have a 75% Increased Mortality Rate.

Taken from the August 14, 2006 Archives of Internal Medicine, an eight year study of men with low Testosterone aged older than forty years found a mortality rate of 35% versus 20% in those with normal levels.  This was concluded even after adjusting for all other risks for mortailty including age, medical co-morbidities, and other covariates.  Also, first year results were excluded to rule acute disease as a cause for an early death. See the research!

The authors also noted that, "Low Testosterone is a common condition in aging associated with decreased muscle mass and insulin resisitance."  As I know and preach, most older adults succumb more to "the frailty syndrome" than the actual age-related disease(s) they suffer from, i.e. cancer, infection, dementia, osteoporosis and unfortunately, a whole lot more.  Also, insulin resistance is a risk for diabetes, hypertension, hypercholesterolemia, heart disease, erectile dysfunction, and the list goes on.  This adds creedence to what we offer, a paradigm shift that identifies and treats the root causes of such age-related diseases. It's proactive and not reactive, a much better course in life!

 

Recent searches I’ve done have revealed more of the probable advantages of TRT in Men deficient in such.  From risk for Diabetes, CAD and CHF, Dementia, Parkinson’s and more, low testosterone has a major role:

·        I very nice review of the importance Testosterone plays in middle aged men can be found in this article, “Men Over 50, An Endangered Species.”  Andropause is reviewed along with its implication (which is remarkable considering this was originally published back in 2001).  Depression, Dementia risks, and libido decline occur more often in men as they age. And many serious age-related metabolic changes also occur, as loss in muscle and bone mass, and increase in visceral fat. Depression only adds to the severity and complexity of these physical changes which occur in aging men.  As I see it, the best way to prevent problems is to treat the root cause, optimizing one’s health and hormonal status before these diseases manifest themselves in a more severe state. See the article at  http://www.medscape.com/viewarticle/416510_1

·        I have seen great benefits of appropriate TRT in Parkinson patients, as far as the gain in strength and improved mood, and overall sense of well being.  I think the increasing frailty and dependence of the patient is the most disturbing to them and the caregiver.  Here it is revealed the higher incidence of testosterone deficiency in PD patients, as well as increased rate of accompanying disorders as depression, and similar “quality of life” issues that proper TRT may only help. This Research addresses these often overlooked, yet critical aspects of the disease to which there is currently no cure.   Here, all patients receiving TRT had significant improvement in such parameters. See the article: http://www.medscape.com/medline/abstract/120202264?prt=true

·        Also, while on that subject, many articles reinforce what we’ve been seeing in our practice. In Alzheimer’s Disease patients, there is also considerable improvement in such “Quality of Life” (QOL) aspects with TRT.  In a recent study by Po H.Lu at Dave Geffen School of Medicine, at six months the treatment group with TRT had an improved QOL, whereas the placebo group showed significant declines overall.  There was also improvements in visual-spatial cognition, which parallels most previous research. Arch. Neurol. 2006;63:1-9. Similar results were found in this earlier article: http://www.medscape.com/viewarticle/519806

·        In treatment resistant Depression, TRT also had significant improvements in hypogonadal men over 50 years old after only 12 weeks in this crossover design study.  To me, it would be interesting to see a “de novo” head to head comparison of TRT vs. traditional antidepressants in this hypogonadal population, or to see if the antidepressant dosing could be weaned later on, in an effort to decrease its many undesirable side effects.  Again, trying to treat the root cause of a disorder.  See the article: http://www.medscape.com/medline/abstract/15681624?prt=true .

·        Lastly, another disease which is severely disabling as we age is Congestive Heart Failure, CHF.  The heart, as a “muscle pumper” of blood, basically fails, most commonly because of Coronary Vessel Disease.  The symptoms are vast and severe, including shortness of breath, fatigue, swelling and more. Many pills are used to help this common malady of the aging heart, all with many unfavorable side effects and risks.  Anticoagulation with Coumadin (Rat Poison) and implantation of a defibrillator are other options with severe CHF. Not a route I want to go down, if I could avoid it, how about you?

 

In this June 2005 presentation at the 87^th meeting of the Endocrine Society, TRT significantly improved QOL and exercise capacity in older men with moderate severe CHF. In this 12 month trial, over one third on TRT even improved by 1 NYHA CHF class.  Exercise capacity also improved significantly, but deteriorated in all those not on TRT.  This is remarkable because TRT had usually been contraindicated in CHF patients; however those earlier studies used improper supraphysiological dosing of Testosterone**.  (Thus the importance of getting TRT from an experienced and qualified doctor that knows how to monitor levels and metabolites, and adjust treatment accordingly).

 

·        There were also other important benefits:  Better mood, cognition, and sense of well being were reported.  Dr. Jones also stated that TRT helps improve the muscle wasting we see with CHF, as such also improves AID patients with cachexia.  See the article: http://www.medscape.com/viewarticle/506223

 

 

**There were no evidences of increased edema, CHF serum makers (BNP), TNF, PSA or Hematocrit levels.

 

The severe, yet common diseases above increase as we age and cause monstrous disabling effects on the aging man.  In conclusion, proper TRT in those low in testosterone can offer a myriad of beneficial effects in aging men.  And these aren’t limited to only the physiological.  Here we see the Quality of Life improved, which shouldn’t be cavalierly dismissed, as there are very few traditional medical therapies that can offer such…and in a relatively safer way, when done appropriately.  

 

If you want to discuss your program or to schedule an evaluation, please do so.  As the above reflects, proper TRT can synergistically improve your health on many important levels. All the hormones should be optimized for the best, and safest route to increased healthspan and longevity.