The commercials bombard men day and night, replacing Viagra as the next big pharmaceutical craze.
“Do you have low libido?” they ask. “Do you have low energy? You may have low T.”
They’re called direct-to-consumer advertisements, and doctors say they are creating a demand for testosterone therapy from aging men who may be going through “male menopause” and want to hold onto their youth and masculinity.
But doctors are growing increasingly worried about the widespread use of the therapy, which they fear could cause a host of problems, from heart issues to strokes to infertility to prostate cancer. Some are refusing to prescribe it. And earlier this month, the Federal Drug Administration joined the chorus of concerned physicians by issuing a warning that prescription testosterone products may cause unintended side effects and should be used with caution, particularly among elderly persons and those with cardiovascular issues.
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“This has become very popular in the last five years,” noted Dr. Luis Gonzalez-Mendoza. “But the jury is still out on whether it’s safe. It does put a load on your heart. It does increase your chances of prostate cancer.”
Gonzalez-Mendoza, a pediatric endocrinologist at Miami Children’s Hospital, believes the testosterone craze will mirror what happened more than a decade ago when menopausal women were widely treated with an estrogen-progestin pill known as Prempro. A large clinical study showed that Prempro increased the risk of breast cancer, blood clots, stroke and heart disease. Doctors stopped prescribing it nearly entirely.
“I don’t have a crystal ball but I think the same thing’s going to happen here,” Gonzalez-Mendoza said.
Doctors sometimes prescribe testosterone therapy after a blood test reveals a testosterone level under 250. A level of 800 to 900 is considered normal. Formerly administered by daily injection, the drug is now a topical cream applied on the armpits.
Yet, according to medical experts, many doctors prescribe the therapy to men who simply complain of fatigue and low libido — even though these symptoms are increasingly common in men over 50. Additionally, they say athletes are using the supplement under the assumption it will provide increased muscle mass as well as energy.
Dr. George Attia, director of the UHealth Fertility Center, said he sometimes sees patients who are experiencing infertility and, after testing the husband’s blood, discovers he has been taking testosterone therapy. He is convinced testosterone treatments directly affect a man’s sperm count adversely.
For example, Attia recently treated a Weston couple who were having fertility issues. When the in vitro procedure didn’t work, Attia tested the man’s semen. Shockingly, he discovered the 37-year-old man had a sperm count of zero. That’s when he asked his patient if he had taken testosterone treatments. The man answered yes, saying he had been prescribed it recently because he was fatigued and could not lose weight.
“He was surprised when I told him he had no sperm,” Attia said. “No one had warned him that it could cause infertility. He was not counseled properly.”
This patient was lucky, and the sperm count rose after the testosterone was discontinued. However, not everyone is so fortunate. Attia said the sperm count — as well as the infertility — can be irreversible if the testosterone therapy is used for extended periods of time.
“I think we need to do more studies on the use of testosterone therapy and whether it leads to infertility,” he said.
Some recent studies done on the long-term effects of testosterone therapy seem to indicate a potential link to cardiac issues, although the findings have not been conclusive.
Hollywood endocrinologist Dr. Paul Jellinger does prescribe the therapy in men with a sperm count lower than 250, but he first counsels them on the potential risks of the drug extensively, while noting the dangers are not proven.
“I have not seen any evidence of cardiac issues with men I’ve treated with the therapy,” Jellinger said. “I am aware there are some reports. As for the link to prostate cancer, that’s an old story. There is no evidence it can cause prostate cancer. There is some evidence it can exacerbate an exisiting condition.”
Jellinger’s concern, like other doctors, is the proliferation of direct-to-consumer ads that are leading men to believe they have “low T” and to ask their doctors for therapy.
“It’s very widely used and excessively in individuals that don’t need it,” he said. “The truth is testosterone levels in men decline with age anyway, so it could be due to normal decline and not a real deficiency. But they put pressure on their doctors for the treatment after seeing the ads.”
Doctors have known that athletes and body builders have long turned to testosterone and steroids to bulk up. Where are they getting the ointment? Jellinger said there may be a black market for the drug. There are also clinics popping up to target men seeking testosterone, say some doctors.
“It’s been going on for a long time,” Jellinger said. “But with the ads, there is a tremendous explosion of requests for testosterone.”
Dr. Howard Berlin, a cardiologist at Memorial Health Systems, actively discourages patients from taking testosterone therapy, even though he acknowledges reports of links to heart and other issues “are up in the air.”
“It can lead to behavioral issues and make men more aggressive and increase red blood cell count,” Berlin said. “I discourage its use. I don’t know what the long-term effect will be.”
According to Gonzalez-Mendoza, 10 to 15 percent of men over 50 may suffer from “low T,” while incidence under 50 is very rare. Since he is a pediatric endocrinologist, when he encounters children and youths with low testosterone, he must prescribe the therapy or they won’t ever go through puberty. The patients then must take the therapy the rest of their lives.