Endogenous Testosterone Levels and Mortality Risk

The medical journal Circulation published a new study this week entitled “Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men.” The role of testosterone in health has long been a controversial topic and the recent steroid hysteria has only fueled the love-hate relationship with steroids in our society.

Reuters reports that “high testosterone linked to men’s lower death risk.” I hope steroid-using bodybuilders do not conclude that higher testosterone levels, even supraphysiologic levels from exogenous testosterone adminstration, are always better than low testosterone levels.

I think that WebMD more accurately describes the culprit associated with the increased mortality in their headline – “Low Testosterone, Early Death?” Higher endogenous testosterone levels were related to lower mortality rates from all causes, particularly cardiovascular disease. Low testosterone levels may be as good a predictive marker for predicting cardiovascular disease risk as lipid profiles i.e. cholesterol and triglyceride levels.

Lead researcher University of Cambridge gerontologist Kay-Tee Shaw writes in the paper:

Men in the top quartile for endogenous testosterone concentrations had 40% lower risk of death due to any cause than men in the bottom quartile, and this relationship appeared independent of age, body mass index, smoking and other lifestyle factors, cardiovascular risk factors, and other hormone levels.

If low testosterone increases mortality risk in men, then it seems logical that testosterone supplement would be in order to optimize testosterone levels in the highest quartile of physiological normal range. Of course, it is never that simple.

No one in mainstream medicine wants to advocate testosterone therapy because there are no studies showing that it is safe. And no one wants to do any studies on testosterone therapy because they are afraid that exogenous testosterone will increase the risk of prostate cancer.

Robert Davis, MD, professor of urology at the University of Rochester, laments the widespread myth regarding the alleged association between testosterone and prostate cancer:

One of the myths is that androgen supplementation will cause a cancer. We know that prostate cancer often regresses when androgen is removed, but there is very little evidence that supplementing to normal levels increases risk of cancer, and some evidence it may lower it.

The situation as described by Dr. Shaw to WedMD:

There has been a worry that testosterone supplementation may increase the risk of prostate cancer, but we did not see any more cases of prostate cancer in men with higher testosterone levels compared with those with lower levels. This is reassuring and should open the way for studies of testosterone supplementation in men with low levels to take place.

 Furthermore, Dr. Khaw acknowledges the problems that have faced estrogen replacement therapy in recent years:

The observational studies of estrogen replacement in women were encouraging, but randomized controlled trials actually showed harm. That has put people off the idea of hormone therapy in men as well. But the observational studies in women were mainly with estrogen supplements and suffered from many biases, as women who took estrogen supplements were different in many other ways from women who didn’t. In contrast, our study in men looked at endogenous testosterone levels, which should have fewer biases.

WebMD: http://men.webmd.com/news/20071127/low-testosterone-early-death

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