Testosterone Hysteria: An Interview with Abraham Morgentaler, MD Part 2
As the legal and medical hysteria mounts over testosterone (T) and testosterone replacement therapy (TRT), we continue our interview with Abraham Morgentaler, MD, the Director of Men’s Health Boston, a professor at Harvard Medical School, and a renowned T expert.
Q: Plaintiff’s lawyers are trolling for “TRT victims” on TV. Your thoughts on the class actions claiming TRT caused heart attacks and strokes?
A: Until the last year, there had been accumulating evidence that T may reduce the risk of cardiovascular events, and it is clear that it improves several important risk factors including reducing fat mass and waist circumference, increasing lean mass, and reducing insulin resistance. The law suits are opportunistic, but are unlikely to prevail based on the evidence. Nonetheless, they have clearly caused concerns for many patients taking or considering TRT.
Q: Were you disappointed with the recommendations of the recent FDA panel on T?
A: The FDA appears concerned that T is being used for indications that were unintended when the FDA created a class label for all T drugs in 1981. At that time, there was limited knowledge of what caused low testosterone levels, and the FDA listed the known causes at that time. We have learned a great deal since then, in particular that the symptoms of T deficiency are caused by low levels of the hormone regardless of what has caused T production to be low. In fact, we can experimentally induce all the symptoms and signs of T deficiency just by lowering T levels. So, I’m disturbed by the FDA’s emphasis on meeting a standard from more than 30 years ago that is no longer relevant. I am not aware of any evidence that T is being abused or prescribed inappropriately more than any other medication.
Q: A prominent cardiologist recently wrote “If you’re taking a medication for low testosterone to ward off the effects of aging – such as decreased libido or fatigue – you should stop taking the drug now.” Response?
A: It is irresponsible to tell people to stop taking a medication prescribed by their physicians without knowing anything about their situations. In addition, the implication that decreased libido or fatigue does not merit treatment is bizarre. In my practice, and in the practices of thousands of healthcare providers around the country, the improvement in quality of life for many men that results from TRT is remarkable. These men feel “normal again,” can resume their intimate relationships with their partners, and can enjoy all the activities at work and at play that make them feel engaged, successful, and happy. I have never had a patient who told me he wanted testosterone to combat aging. Instead, men come in with symptoms. After evaluation, some of those men will be found to have low T levels, which often causes reduced libido and fatigue, as well as other symptoms, and treatment effectively treats those symptoms in a majority of men. There is nothing radical about any of this, it is just good medicine.
Q: The current medical philosophy almost seems to suggest that TRT for hypogonadism is only indicated where symptoms exist and the total T levels are below the “normal” range (i.e., below 300ng/dl). But might men in the high “normal” range enjoy better quality of life than men in the lower quartile?
A: In several studies of healthy populations, men with higher levels of testosterone have been shown to have a lower risk of developing diabetes, the metabolic syndrome, fractures, and death, compared with men with lower testosterone levels.
Q: You’ve challenged the evidence that T causes prostate cancer. The link had been pretty much debunked. What’s your response to the new rat study from the University of Illinois in Chicago trying to breathe new life into the claim?
A: One must be extremely cautious about extrapolating results from animal studies to humans. In this particular case, rats were given a powerful carcinogen to induce cancers together with an anti-testosterone agent before being treated with T. Although they did find more cancers in these rats after T treatment, it is difficult to know what this means. In humans, there is extensive data that shows that higher levels of T are not associated with prostate cancer. It is naive to suggest that a highly experimental study in an inbred strain of rats given carcinogens trumps well-performed studies in humans.
Rick Collins, JD, CSCS [www.rickcollins.com] is the lawyer that members of the bodybuilding community and nutritional supplement industry turn to when they need legal help or representation. [© Rick Collins, 2014. Adapted from Rick’s column in Muscular Development magazine. All rights reserved. For informational purposes only, not to be construed as legal or medical advice.]