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Benefits of testosterone treatment unknown, research shows
January 10, 2007ROCHESTER, Minn. - Little research exists demonstrating that testosterone is both safe from the cardiovascular standpoint and effective to treat sexual dysfunction, reveal Mayo Clinic researchers in two new studies.
In articles published in the January issue of Mayo Clinic Proceedings, Mayo Clinic physicians call for large studies to help clinicians and patients make informed decisions about when testosterone should be prescribed.
"One of the initial surprises is how limited the research evidence is regarding whether testosterone is an effective treatment for sexual dysfunction while being safe from the cardiovascular disease standpoint," says Victor M. Montori, M.D., MSc, lead researcher for Mayo Clinic's Knowledge and Encounter Research Unit, and an author of the two studies in Mayo Clinic Proceedings. "There is no way for physicians to be certain when prescribing testosterone that, on average, it's doing more good than harm."
Both studies involved review and meta-analysis of randomized trials to assess the effect of testosterone on sexual dysfunction and cardiovascular events. Authors determined that no strong evidence exists showing testosterone doesn't cause cardiovascular harm and results regarding its impact on sexual dysfunction are inconsistent.
In 2004, the Endocrine Society established a task force to generate evidence-based guidelines about the use of testosterone in treating men. Dr. Montori says Mayo researchers joined the effort in order to help the Endocrine Society provide recommendations based on up-to-date research.
"We found that the evidence for whether men are better off being treated with testosterone is much weaker than the evidence for giving estrogen to post-menopausal women was before the big estrogen trials came out," Dr. Montori says.
Despite the weak evidence supporting testosterone's efficacy, drug companies have successfully driven its sale, Dr. Montori says. Currently, physicians may be prescribing testosterone to otherwise healthy men who report poor quality of life, limited sex drive and fatigue and may have somewhat low testosterone levels.
These clinicians and their patients will be "thoroughly shocked" to discover the limited evidence supporting the drug's effectiveness in treating sexual dysfunction and the limited data supporting its cardiovascular safety, Dr. Montori says. "Researchers should conduct trials measuring the outcomes of testosterone treatment that are important to patients in order to avoid repeating the estrogen disaster," he says.
Mayo Clinic
Both studies involved review and meta-analysis of randomized trials to assess the effect of testosterone on sexual dysfunction and cardiovascular events. Authors determined that no strong evidence exists showing testosterone doesn't cause cardiovascular harm and results regarding its impact on sexual dysfunction are inconsistent.
In 2004, the Endocrine Society established a task force to generate evidence-based guidelines about the use of testosterone in treating men. Dr. Montori says Mayo researchers joined the effort in order to help the Endocrine Society provide recommendations based on up-to-date research.
"We found that the evidence for whether men are better off being treated with testosterone is much weaker than the evidence for giving estrogen to post-menopausal women was before the big estrogen trials came out," Dr. Montori says.
Despite the weak evidence supporting testosterone's efficacy, drug companies have successfully driven its sale, Dr. Montori says. Currently, physicians may be prescribing testosterone to otherwise healthy men who report poor quality of life, limited sex drive and fatigue and may have somewhat low testosterone levels.
These clinicians and their patients will be "thoroughly shocked" to discover the limited evidence supporting the drug's effectiveness in treating sexual dysfunction and the limited data supporting its cardiovascular safety, Dr. Montori says. "Researchers should conduct trials measuring the outcomes of testosterone treatment that are important to patients in order to avoid repeating the estrogen disaster," he says.
Mayo Clinic
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Researchers at Johns Hopkins are reporting what is believed to be the first conclusive evidence in men that the long-term ill effects of vitamin D deficiency are amplified by lower levels of the key sex hormone estrogen, but not testosterone.
Pilot study relates phthalate exposure to less-masculine play by boys
A study of 145 preschool children reports, for the first time, that when the concentrations of two common phthalates in mothers' prenatal urine are elevated their sons are less likely to play with male-typical toys and games, such as trucks and play fighting.
Hormone that affects finger length key to social behavior
The hormones, called androgens, are important in the development of masculine characteristics such as aggression and strength.
Postmenopausal women with higher testosterone levels
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Fetal study highlights impact of stress on male fertility
Exposure to a combination of excess stress hormones and chemicals while in the womb could affect a man's fertility in later life, a study suggests.
Studies examine how living conditions impact reproductive health
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BUSM researchers propose a relationship between androgen deficiency and cardiovascular disease
Researchers from Boston University School of Medicine (BUSM) in collaboration with researchers from Lahey Clinic Northshore, Peabody, Mass., believe that androgen deficiency might be the underlying cause for a variety of common clinical conditions, including diabetes, erectile dysfunction, metabolic syndrome and cardiovascular disease (CVD).
Prostate cancer patients on hormone therapy at increased risk for various heart diseases
New research has found that hormone therapy used to treat men with advanced prostate cancer is associated with an increased chance of developing various heart problems. Some choices of therapy appear, however, to be less risky than others.
Obesity increases risk of prostate cancer recurrence for both blacks and whites
A new look at a large database of prostate cancer patients shows that obesity plays no favorites when it comes to increasing the risk of recurrence after surgery: Being way overweight is equally bad for blacks and whites, say researchers at Duke University Medical Center.
Life and death in the living brain
Like clockwork, brain regions in many songbird species expand and shrink seasonally in response to hormones. Now, for the first time, University of Washington neurobiologists have interrupted this natural "annual remodeling" of the brain and have shown that there is a direct link between the death of old neurons and their replacement by newly born ones in a living vertebrate.
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