TOP3PILLS

Q: Testosterone is under fire these days. Why do you think there’s such a backlash in the medical community against LOW T?

A:Testosterone use elicits a remarkable degree of passion, especially among those opposed to it. Some of this appears to be a reaction against over-the-top claims by supplement providers and anti-aging enthusiasts, some is barely disguised antipathy against the pharmaceutical industry, and I believe a lot of it comes from individuals who are anti-sex. A similar story played out in the recent past with women and sex hormones also, where a very small reported risk in a highly publicized study (the Women’s Health Initiative) caused a dramatic shift in our treatment of women with menopause that was never scientifically based.

Q: What are your thoughts on the recent TESTOSTERONE study linking LOW T with increased heart attacks and strokes?

A: The JAMA study reported that a group of testosterone-deficient men that received T prescriptions had 29% more CVE’s (heart attack, stroke, or death) than a similar, untreated group. This study has already undergone two major corrections. Troublingly, neither the authors nor JAMA editors disclosed that the actual percentages of individuals that experienced an adverse event was lower by half in the T group, and that the researchers’ conclusion was derived from a brand-new, statistical methodology that has never been validated. Even more concerning was that the authors subsequently reported errors in their data that involved more than 1000 individuals, and discovered that nearly 10% of the “all-male” population was actually women! Due to these errors, more than 160 of the leading testosterone experts in the world, as well as 29 medical societies, have called for retraction of this article, asserting that “the data are no longer credible.”

Q: IS THERE AN “absolute” risk for both groups as well under 1%. What’s your take?

A: The article by Finkle et al. was scientifically unsound. It compared heart attack rates for two periods of time that are unrelated. One is how often physicians prescribed T to men with a recent heart attack, and the second is the actual rate of heart attacks in men that received a T prescription. It shouldn’t be a surprise that physicians were reluctant to prescribe T to men just recovering from their heart attack. In any case, in both groups, and for all ages, the actual rates of reported heart attacks were substantially lower than what is expected for that population.