Over the past 10 years or so, the number of men 40 and older who take testosterone replacement therapy (TRT) has tripled. With that rise has come a debate over the safety of TRT, especially for men with heart disease. Two large studies, one published last fall and the other in January, suggest that TRT poses severe, sometimes fatal risks, including heart attack and other serious problems.
Both studies have vocal critics. They claim the data doesn't support the studies' conclusions.
Men rarely see Thomas J. Weida, MD, for medical tests without prodding from a wife or girlfriend. When they do show up, Weida jokes that he “can see the drag marks on the carpet.”
It’s amusing, of course. But it can quickly turn serious when a man ignores important symptoms. Weida says he knows of men who got away with ignoring chest pain for a couple of weeks. Eventually, though, they died of heart attacks.
To add to the mix, another large study presented in May concludes that TRT does not harm the heart. It may even protect it. And a new study involving 25,000 men funded by the National Institutes of Health found no increased risk of heart attack linked to testosterone use. Confused yet?
One thing is certain: As men age, their testosterone reserves start to slip. Over time, that can lead to a less active libido, less vitality, and an unfamiliar lack of confidence and motivation.
Can TRT restore a man's youthful vigor safely? "We don't know," says endocrinologist and men's health specialist Shalender Bhasin, MD, of Brigham and Women's Hospital in Boston.
"It's important to acknowledge the uncertainties about benefits as well as risks of testosterone therapy for age-related testosterone decline," Bhasin says of the lack of strong evidence supporting TRT use in older men.
He says TRT has not been approved to restore the testosterone decline that happens naturally with aging.
So, what's an aging man to do? Bhasin suggests:
Have a real conversation with your doctor. A blood test for testosterone and a review of symptoms will help establish whether you have low testosterone. If you both decide that TRT is worth a try, you'll need follow-up exams with regular blood tests to see how you're responding.
Take good care of yourself. Exercise and a healthy diet can help raise testosterone levels. For example, men who are mildly or moderately obese can boost their testosterone by losing weight, Bhasin says.
Here are the five key questions to ask your doctor, says endocrinologist Bradley D. Anawalt, MD. He's the chair of the Hormone Health Network and professor of medicine at the University of Washington in Seattle.