Bioidentical Hormones 101 
The Book, by Jeffrey Dach MD

Chapter 24. Low Testosterone Could Be Killing You

Section Six: Low Testosterone Diagnosis and Treatment

Low Testosterone Could Be Killing You Jeffrey Dach MDChapter 24. Low Testosterone Could Be Killing You

Forty Per Cent More Likely to Die

The recent medical literature shows that low testosterone is associated with increased mortality.(1-3)  One study, published in 2008, tracked 800 California men 50 to 91 years old.  Testosterone levels were measured at the beginning of the study, and the men’s health was tracked over 20 years.  Low testosterone symptoms reported by these men included decreased libido, erectile dysfunction, fatigue, loss of strength, decrease in bone density and decreased muscle mass.  The men with low testosterone tended to be overweight, and had increased risk for cardiovascular disease and diabetes. Men with the lowest testosterone, below 241 total serum level, had a FORTY percent increase in mortality.(2)  I find this astounding.

Above Left Image: Testosterone chemical structure, courtesy of wikimedia commons.

A Study of EPIC Proportions

The authors of the EPIC Study published in Circulation 2007 said,

" In men, endogenous testosterone concentrations are inversely related to mortality due to cardiovascular disease and all causes. Low testosterone may be a predictive marker for those at high risk of cardiovascular disease."(9)

Testosterone Blocking Drugs Increase Mortality

A study by Dr. Amy Dosoretz, a  radiation oncology resident with the Harvard Radiation Oncology Program in Boston  showed that patients treated with the testosterone blocking drugs to  "knock out testosterone to shrink the prostate"  had a poor outcome.  They had a 20% increase in mortality.(6)(7)   A discovery such as this, that a treatment that carries a 20 per cent increased mortality means the treatment is discredited and should be discarded, and should no longer be the "standard of care".  Instead it should be considered "substandard care".  However, old habits in medicine have a way of lingering on, so it may take a few more years for this to change.

FDA Approval Would Be Denied

FDA approval requires a drug to produce a benefit greater than placebo.  Had Amy Doseretz' study been submitted to the FDA for drug approval, the FDA would never have been granted approval for the use of the testosterone blocker, Lupron™, for prostate cancer.  A detrimental result of 20 per cent increased mortality would spell disaster, and the FDA approval would be denied.

Other Study Confirms Findings

Dr Amy Dosoretz was not the first to raise doubts about the benefits of testosterone blockade (used as a treatment for prostate cancer).  A previous study by Grace L. Lu-Yao was published JAMA 2008 showing that androgen deprivation therapy is not associated with improved survival. (8)

Important Point:

Having a low testosterone level is associated with 40% increased mortality.  Blocking testosterone levels with drugs is associated with a 20% increased mortality.

For references and links, see my web site:

Chapter 24. Low Testosterone Could Be Killing You

(1) Low Serum Testosterone and Mortality in Male Veterans Arch Intern Med. 2006;166:1660-1665 Molly M. Shores, MD; Alvin M. Matsumoto, MD; Kevin L. Sloan, MD; Daniel R. Kivlahan, PhD .

(2) The Journal of Clinical Endocrinology & Metabolism 2008 Jan;93(1):68-75. Low Serum Testosterone and Mortality in Older Men. Gail A. Laughlin, Elizabeth Barrett-Connor and Jaclyn Bergstrom.

Low Testosterone Could Kill You. Low Levels of Male Hormone May be More Dangerous Than Previously Thought By SUPINDA BUNYAVANICH, M.D. ABC News Medical Unit June 6, 2007

(4) Testosterone Replacement For Men With Low Testosterone Improves Liver Function, Metabolic Syndrome.  Medical News Today. June 13, 2009.

(5) Low testosterone levels linked to depression in older men March 2008. Medical Net News.

(6)  Hormone Therapy Not Best for Older Prostate Cancer Patients. Study found giving it before radiation raised death risk 20% in this group By Alan Mozes HealthDay Reporter. TUESDAY, Sept. 23

(7)  Hormone Therapy Before Brachytherapy May Increase Mortality in Prostate Cancer: Presented at ASTRO By Martha Kerr, BSN BOSTON -- September 24, 2008 -- [Presentation title: Mortality in Men Age 70 or More With Localized Prostate Cancer Treated With Brachytherapy With or Without Neoadjuvant Hormonal Therapy. Abstract 84]

(8) Survival Following Primary Androgen Deprivation Therapy Among Men With Localized Prostate Cancer. Grace L. Lu-Yao, MPH, PhD; Peter C. Albertsen, MD; Dirk F. Moore, PhD; Weichung Shih, PhD; Yong Lin, PhD; Robert S. DiPaola, MD; Siu-Long Yao, MD . JAMA. 2008;300(2):173-181.

(9)   Circulation. 2007;116:2694-2701. Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men. European Prospective Investigation Into Cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Kay-Tee Khaw, MBBChir, FRCP; Mitch Dowsett, PhD; Elizabeth Folkerd, PhD; Sheila Bingham, PhD; Nicholas Wareham, MBBS, PhD; Robert Luben, BSc; Ailsa Welch, PhD; Nicholas Day, PhD

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