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Hormone Replacement for Men: Pros, Cons

Testosterone Replacement May Lower Risk of Heart Disease, Diabetes, Death, but Long-Term Effects Unclear

Testosterone Replacement Therapy: Follow-up

"There are some precautions with testosterone supplementation," Saad tells WebMD. "We need to monitor the prostate."

"It is well known that with prostate cancer, the cancer is usually dependent on testosterone. Prostate cancer is a slow-growing tumor." Cancer of the gland must be ruled out before starting supplements, he says. He also advises routine prostate checkups while on treatment.

A test to monitor red blood cell formation, called a hematocrit, is needed, too. "Testosterone increases red blood cells," he says. In excess, it can theoretically boost heart attack or stroke risk.

Testosterone and Death Risk

Low testosterone levels are associated with an increased risk of death, according to Robin Haring, a researcher from the Institute for Community Medicine at Ernst-Moritz-Arndt University in Griefswald, Germany, who presented the finding at the meeting.

He evaluated data on nearly 2,000 men, aged 20 to 79, who participated in the Study of Health in Pomerania, following them for seven years until August 2007. He noted testosterone levels, age, weight, smoking habits, and physical activity. The drugmaker Novo Nordisk partly funded the study.

During the follow-up, 226 men died. "Men with low testosterone have a more than twofold higher risk of death during the follow-up period," he says.

They were more likely to die of cardiovascular disease and cancer, but not of other causes.

Testosterone Replacement Therapy: Long-Term Effects Unknown

Another researcher, Jane F. Reckelhoff, PhD, professor of physiology and biophysics at the University of Mississippi Medical Center in Jackson, offers a caveat about supplemental testosterone: "We don't know what the long-terms effects are. The safety studies have not been done and they need to be done."

She reviewed the studies for WebMD and has published on a review about testosterone supplements for the American Journal of Physiology Renal Physiology.

Her chief concerns: "Testosterone [in excess] can increase blood pressure and compromise kidney function."

But an advocate of testosterone replacement therapy, Martin Miner, MD, co-director of the Men's Health Center at the Miriam Hospital of Brown University in Providence, R.I., says the studies show that restoring testosterone when it is low improves metabolic syndrome factors and could help prevent type 2 diabetes and cardiovascular risks.

He agrees close monitoring of men on testosterone is needed. "Checking hematocrit, PSA (prostate-specific antigen), and lower urinary tract symptoms in men is vital to the management of testosterone replacement therapy," he says.

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