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Testosterone replacement for men 'trade-off with risks'

Testosterone replacement for men 'trade-off with risks'

Cognition trial - This trial sought to determine if testosterone treatment improved cognition in older men with age-associated memory impairment (AAMI), a mild form of impairment, distinct from dementia. The results add to evidence that challenges bold anti-aging claims of popular supplements.

Response: The recently released studies reported that testosterone treatment improved bone density and anemia for men over 65 with low testosterone.

"Final decisions about testosterone treatment for older men will depend on balancing the results from these seven TTrials with the results from a much larger and longer term trial created to assess cardiovascular and prostate risk in the future", said Snyder.

To stress this, the Food and Drug Administration has increased its warning about the cardiac side effects of testosterone supplements. Men aged 65 and older with low testosterone levels were involved.

A separate study published Tuesday in JAMA Internal Medicine found that men using prescription testosterone gel, patches or injections had fewer heart attacks and strokes during about three years of follow-up than non-users.

The European association of Urology recommends other possible causes of low testosterone, such as obesity, should be treated before testosterone therapy is considered. Many of these men also have problems that could be related to low testosterone, including impaired cognition, anemia, cardiovascular disease, diminished sexual function, decreased mobility and fatigue.

However, the new findings cast a shadow on the long-term effects of testosterone on heart health, Anawalt said. The treatment also increased hemoglobin concentrations, corrected the anemia of men who had no other identifiable cause of anemia and corrected the anemia of men who had an identifiable cause, such as iron deficiency. The Bone Trial included 189 of the 790 men in the overall study.

Researchers found that testosterone treatment improved bone density and estimated bone strength, as determined by quantitative computed tomography (CT).




Handelsman then takes the medical profession to task, noting that "testosterone overprescribing has been propelled not only by direct-to-consumer advertising, but also with the complicity of some professional organizations and physicians that have supported redefinition of the term hypogonadism through permissive guidelines appearing to minimize the fundamental distinction between pathological hypogonadism and age-related, low circulating testosterone".

For men with low testosterone, twelve months of daily application of a testosterone gel was linked with an increase in hemoglobin levels and bone density.

Taken together, says Dr. David Handelsman of the University of Sydney and Concord Hospital in Australia, the TTrials "do not materially change the unfavorable balance of safety and efficacy to initiate testosterone treatment". The study was originally done because there had been suggestions that testosterone has heart benefits. Testosterone supplementation has not been demonstrated to have clear benefit but may increase risk of prostate cancer.

Clarifying testosterone's effects on heart problems, fractures and age-related disability will require larger, longer studies, said Dr. Evan Hadley of the National Institute on Aging. With that said narrower arteries have also surfaced with testosterone use compared to those with fake gel. Patients were allocated by minimization to either placebo or testosterone gel titrated to normal serum testosterone range (defined as the range in normal, young males). AbbVie Pharmaceuticals provided its gel for the study and helped pay for the research but had no other role in the study.

PATTI NEIGHMOND, BYLINE: The studies, called the TTrials, were conducted at 12 medical centers across the country. However, the Testosterone Trials were too short-term to assess this risk.

SUSAN ELLENBERG: It tells them that this is not likely to be a magic bullet for them but that it may lead to some improvements in some areas and probably not in others. Additionally, the study sample was small and had limited ethnic diversity.

"I would say, ‚We have uncertainty about the health effects of testosterone and your risk of heart attacks".

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