BY RALPH BLUM
Low testosterone or “low T,” also called hypogonadism,
affects millions of aging men. Testosterone levels normally peak in a man’s
20s, then fall by 1% to 2% per year. Indisputably, low T is responsible for
reduced sex drive and sense of vitality, erectile dysfunction, decreased
energy, and diminished muscle mass and bone density. As the poet T.S. Eliot
reminded us, time the healer is also time the destroyer.
Men through the ages have tried outlandish cures for
impotence, including chewing the roasted penis of a wolf! More recently they have plunged the family
jewels into cold baths, choked down heaping spoonfuls of wheat germ, swallowed
vitamins and most recently stockpiled Viagra.
When, in 1939, two scientists shared the Nobel Prize
for Chemistry for their work in isolating and identifying testosterone, the mad
rush for injected, implanted, inhaled or absorbed versions of the hormone
began, promising, in the words of one product’s pitch, “power, performance,
In 2013, U.S. sales of testosterone reached $2.4
billion. According to Global Industry Analysts, the market is projected to
swell to $3.8 billion by 2018. Moreover, in 2013, 7.5 million prescriptions for
testosterone were written. And all this is happening without explicit FDA
approval. There have been few, if any, large, randomized studies on the
long-term risks or benefits of testosterone supplementation. Some maintain that
we are undergoing a massive science experiment with unknown risks. But foggy
science has not deterred Big Pharma from spending untold millions to encourage
those of us who are wan, limp and flabby to climb onto the low T bandwagon.
Meanwhile, the most heated debate is centered on
whether testosterone fuels prostate cancer. Not long ago, the consensus was
that, as far as prostate cancer cells were concerned, testosterone was nature’s
perfect food. It was like spinach to Popeye. Suppressing the hormone is still a
standard part of treating the disease. But attitudes are changing.
The debate goes something like this: If it’s true that
testosterone fuels prostate cancer, why do most men develop the disease when
they are older and their testosterone levels are dropping? Others,
however, point out that when men take hormone therapy that virtually stops the
production of testosterone, tumors regress. So wouldn’t the opposite be true--adding
testosterone should be expected to accelerate tumor growth? I personally
believe that my episode of hormone treatment—monthly Lupron injections over a
15 months’ period—helped to delay the growth of my non-aggressive cancer for
So far a few small studies of using testosterone in
men with prostate cancer have shown fairly positive results. For example, men
who had been treated for prostate cancer and who then received testosterone
therapy did not appear to have an increased risk of recurrent disease. But it’s
impossible to make broad, generalized statements based on these studies.
Chances are the result will depend on a number of variables, not the least of
which is the seriousness of the cancer. It seems likely that a man with
low-risk of disease recurrence would also have low-risk of testosterone
creating a problem. Therefore, it would seem ridiculous to deny that man
testosterone when it would improve his quality of life.
There has been a major push for reconsidering
testosterone therapy from the large population of men who have been treated for
prostate cancer over the last 10-25 years. No surprise there. Which of us
wouldn’t prefer to be firm and sharp rather than soft and dull? But remember,
marketers are spending millions to raise our expectations, and testosterone is
not a silver bullet.
In September, the FDA is gathering a group of experts
for a T summit. But it’s doubtful if they will clarify a topic that has more
guesses and theories than real answers based on reliable information. Bottom
line it is our decision when the conditions are right to use testosterone, and
when to refrain. As the old saying goes, “You pays your money and you takes