Recently, a study published in JAMA concluded that testosterone replacement therapy increased the risk of cardiovascular events. However, the study’s own data would seem to indicate a different conclusion. Of the 7,486 men in the group not receiving testosterone therapy, 681 died, 420 had myocardial infarctions, and 486 had strokes. That leads to 1,587 events, or a total of 21.2%. Of the 1,223 patients receiving testosterone therapy, 67 died, 23 had myocardial infarctions, and 33 had strokes. That was 123 total events, or 10.1%. Therefore, 10.1% of males receiving testosterone therapy, versus 21.2% in males not receiving the therapy experienced cardiovascular events. Although this was a high risk group, those taking the testosterone therapy clearly had a far better outcome. Even with non-therapeutic dosing. It is puzzling why the researchers would report the information in this misleading fashion. It reminds me of a well-known rock song from the 70’s, “Mysteries and Mayhem”, in which the lyrics relate, “… I can’t make it, I can’t figure it out. This dream is driving me crazy. I gotta know what it’s all about”. This study does, however, provide an illustrative example of how statistics can be used to mold data in ways that can be misleading. Unfortunately, but predictably, the mainstream media, including the NY Times and USA Today, latched on to the opportunity to disparage the use of testosterone replacement therapy. What I have always found troubling is that the media rarely takes the time to engage in responsible journalism, fact checking, or a legitimate effort to provide a balanced portrayal. I anticipate that reader’s perception would have been different if the NY Times article may have been titled, “Low dose testosterone replacement shows a 50% reduction in cardiovascular events in high risk older men”. This would have certainly been more factually accurate, and journalistically ethical. It is of interest to note that about a month later another JAMA article contradicted the previous publication by showing a near 50% improvement in cardiovascular outcomes in males taking testosterone therapy. It is ironic that the main stream media did not bother to ‘update’ their previous negative commentary. In addition, numerous other studies have shown a positive correlation in males taking testosterone therapy. A more recent Meta-analysis looked at about 100 studies which, in summation, showed very positive results in reducing all causes of mortality and morbidity with testosterone therapy. As far back as 1942 the New England Journal of Medicine published a trial in which testosterone injections reduced the frequency of angina attacks, and patients experienced increased tolerance for physical activity. The improvements even persisted for 2-12 months following the discontinuation of the therapy. Certainly, doctors working within the field of endocrinology, integrative medicine, or hormone replacement therapy, are well familiar with the clinical benefits of testosterone. Additionally it is hard to ignore the flurry of television commercials touting the treatment of “low T” syndrome. This includes decreased libido, low physical strength and endurance, decreased physical capacity, poor response to exercise, tendency for weight gain, glucose control and erectile function.(to name a few). Testosterone replacement, either by injections, transdermal creams or gels, or pellet implants, has been shown to considerably improve these symptoms. Sometimes dramatically. Not every male patient is necessarily a candidate for testosterone therapy. However, individuals suitably treated can experience a very positive impact. It is unfortunate that poorly interpreted negative studies are capable of generating so much confusion in the public’s mind. On a separate trajectory it also tends to garner the attention of opportunists within the legal profession. Following the JAMA publication, there were five lawsuits filed against Abbott Laboratories by men who had a myocardial infarction or stroke. This was presumably after starting testosterone replacement therapy. It will be interesting to see how evidence gleaned from a misinterpreted study will be used in Court proceedings. If one were to extrapolate this concept, we could assume that any intervention that can increase testosterone levels could also become fodder for filing lawsuits. Examples that come to mind would include sleep quality. It has been shown for men who have higher quality sleep of 8 hours in duration that the percent increase in total testosterone can be about 30%. This is even a better result than the study published in JAMA. I can presume it would not long before attorneys begin filing class action lawsuits against the makers of quality mattresses. Interestingly, sun exposure can increase testosterone for males about 120%. If sun exposure is on the genital area it can increase up to 200%. I suppose the lawsuits involving men engaging in physician advised nude gardening would germinate a cornucopia of legal entanglements on many levels. Finally, we should not forget about watching football and soccer games on television. Particularly if your team is winning, your levels of testosterone can rise significantly. Maybe the next target of the legal profession could be the NFL. This certainly adds more to the “Mayhem” factor to use the analogy of the Kansas song.
~ Dr. Guyer
