I will comment on only 3 of Dr. Morales's statements, primarily because I agree with him in principle. Testosterone replacement has a positive effect on sexual and cardiovascular health and probably doesn't directly cause prostate cancer.
Dr. Morales asks for some references to support my argument and “for our own edification.”1To Dr. Morales and fellow readers I would recommend Darby and Anawalt's article2 on diagnosing and treating male hypogonadism, Jockenhövel's paper3 on testosterone therapy and Seftel's article4 about the pharmacologic monitoring and safety of testosterone therapy.
Dr. Morales states that the “con side is defensible only when TDS is diagnosed and managed incompetently.”1 It is difficult to diagnose and manage a disease that hasn't been accurately described!5 Dr. Morales admits that there are no good tools and there is significant confusion over the appropriate testosterone measurement to use. Add to this the large grey zone of patients that have low normal or slightly low testosterone levels and some of the soft symptoms of andropause, and we have further ambiguity. A study that stratified these patients by symptoms and testosterone levels and gave us some idea of treatment successes would be helpful. Can't find one. Competence remains an issue for all of us.
“The absurd view that TDS is an invention of industry … does not merit further discussion”1 is the second statement of interest. Testosterone is a therapy searching for an indication. Ask our primary care physicians and urologists how they feel about andropause and about their success in treating this population. Industry continues to advertise heavily and spend money on marketing and little on the science of testosterone. The most recent meeting of the International Society for the Study of the Aging Male was a testosterone fest and after looking on http://clinicaltrials.gov,6 I've yet to find a trial registered that will help us determine who, outside the profoundly hypogonadal male who is not in question here, will benefit from testosterone replacement therapy. Until we have more science, testosterone replacement therapy for the andropausal man will remain in the antiaging section along with Botox, hair transplantation and a myriad of natural supplements. Unfortunately, our patients, not Industry, will be paying for the observational data.
Footnotes
This article has been peer reviewed.
Competing interests: Dr. Casey is a member of the Solvay Pharmaceuticals Advisory Board and of the Paladin Labs Advisory Board.
References
- 1.Morales A. The use of hormonal therapy in “andropause”: the pro side; rebuttal. CUAJ 2008;2:43; 49. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Darby E, Anawalt BD. Male hypogonadism: an update on diagnosis and treatment. Treat Endocrinol 2005;4:293-309. [DOI] [PubMed] [Google Scholar]
- 3.Jockenhövel F. Testosterone therapy — what, when and to whom? Aging Male 2004;7:319-24. [DOI] [PubMed] [Google Scholar]
- 4.Seftel A. Testosterone replacement therapy for male hypogonadism: part III. Pharmacologic and clinical profiles, monitoring, safety issues, and potential future agents. Int J Impot Res 2007;19:2-24. [DOI] [PubMed] [Google Scholar]
- 5.Kazi M, Geraci SA, Koch CA. Considerations for the diagnosis and treatment of testosterone deficiency in elderly men. Am J Med 2007;120:835-40. [DOI] [PubMed] [Google Scholar]
- 6.Clinicaltrails.gov: a service of the US National Institutes of Health. Available: http:// clinicaltrials.gov/ (accessed 2007 Dec 30). [Google Scholar]