The media was again splattered with bad news about testosterone therapy this week. On Wednesday, Jan. 29, 2014, Finkle and colleagues published a study in the journalPlos One that exhibited an increased risk of heart attacks in testosterone users in the first 90 days of therapy, and the risk was higher in men who had had a history of cardiovascular disease. There are many problems with the data in this study and others like it that have lead to attention-grabbing headlines about how treatment of low testosterone levels may put men at undue risk. Similar to a November 2013 JAMAstudy of testosterone risks that I reviewed in a prior post, this current study has multiple flaws that make its conclusions essentially meaningless. Neither study assessed testosterone levels of patients before and during therapy. There are other critical blood tests that should be done that were not being done during the treatment of the VA men or in the current study, including blood counts and estrogen levels. Higher red blood cell counts and higher estrogen levels are known issues that may occur in men given testosterone therapy. Without assessment of testosterone levels, red blood cell counts and estrogen levels prior to and during therapy, it is impossible to tell if a patient is a proper candidate for therapy and if they are tolerating the therapy well.
These newer studies have prompted some to ask for warnings on testosterone therapy and to educate their patients on possible increased risks of heart disease. Doctors are the ones who need more education here. Physicians should be educated on the possible issues they may encounter with patients on testosterone therapy, including higher levels of red blood cells and elevated levels of estrogen. Physicians should monitor their patients’ blood cell counts and estrogen levels on testosterone therapy to assess for these risk factors for cardiovascular disease. If a patient has a high red blood cell count, the dose of the testosterone can be decreased or the patient can be sent for blood donation to reduce the high red blood cell count and thus any increased risks of clots or heart attacks. Additionally, high estrogen levels may increase the risk of heart attack and stroke. There are medications that can be prescribed to control high estrogen levels and keep estrogen in the proper, low risk range. These precautions need to be used when prescribing testosterone therapy and studies need to be done reflecting results of testosterone use when these precautions are followed.
This article originally appeared in the Huffington Post. To read the full post, click here.