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Testosterone Revisited: 6 New Degrees of Separation

Testosterone Revisited: 6 New Degrees of Separation

  • Testosterone should be a controlled substance.—Author Lisa Scottoline

  • Testosterone Lowers Cardiovascular Risks. Testosterone replacement therapy (TRT) is not linked with increased cardiovascular (CV) risks in men with androgen deficiency. In this study, the primary outcome was a composite of CV end points, eg, acute myocardial infarction, coronary revascularization, unstable angina, stroke, transient ischemic attack, and sudden cardiac death. The risk of CV outcomes was lower in ever dispensed testosterone men than in never dispensed men during long-term follow-up.

  • Higher Hemoglobin in Older Men With Anemia. Testosterone treatment significantly increases hemoglobin levels in older men with low testosterone levels who have unexplained anemia and those who have anemia from known causes, such as iron deficiency. Measurement of testosterone levels is suggested in men aged ≥ 65 years who have unexplained anemia and symptoms of low testosterone levels. No recognized cause can be found in one-third of older men who have anemia.

  • Treatment Boosts Bone Density, Strength in Older Men. Testosterone treatment of older men who have low testosterone levels significantly increased volumetric trabecular bone mineral density of the lumbar spine and estimated bone strength. Whether testosterone treatment also reduces fracture risk has not been determined.

  • No Help for Cognitive Function. Testosterone treatment for older men with low testosterone levels and age-associated memory impairment was not significantly associated with improved memory or other cognitive functions. Testosterone was not associated with significant differences in visual memory, executive function, or spatial ability. The findings do not support the use of testosterone for the treatment of age-associated memory decline in older men with symptomatic hypogonadism.

  • Testosterone Gel Builds Coronary Artery Plaque Volume. In older men who have symptomatic hypogonadism, treatment with testosterone gel was associated with a significantly greater increase in noncalcified coronary artery plaque volume compared with placebo. The clinical significance is not well understood.

  • Older Men Realize Other Testosterone Benefits. Testosterone treatment that raised testosterone concentrations in symptomatic men aged ≥ 65 years from moderately low to the mid-normal range for men aged 19 to 40 years had the following effects: sexual function, moderate benefit; mood and depressive symptoms, some benefit; vitality and walking distance, no significant benefit. No conclusions were drawn about treatment risks.

Testosterone levels decrease as men age, and the lower testosterone levels in older men may contribute to a variety of symptoms and conditions. Earlier studies of testosterone treatment have produced inconclusive results, but some very recent studies suggest that testosterone treatment for older men with low testosterone levels could have beneficial effects.

Scroll through the slides above for the latest findings.


Find links to studies/abstracts below.

Testosterone Lowers Cardiovascular Risks (JAMA Internal Med)

Higher Hemoglobin in Older Men with Anemia (JAMA Internal Med)

Treatment Boosts Bone Density, Strength in Older Men (JAMA Internal Med)

No Help for Cognitive Function (JAMA)

Testosterone Gel Builds Coronary Artery Plaque Volume (JAMA)

Older Men Realize Other Testosterone Benefits (NEJM)



Every patient must be thoroughly evaluated prior to beginning TRT and closely monitored while on TRT. With older patients with considerably lower serum levels of free testosterone, slowly increase the dose and monitor closely. Many of these patients should be evaluated for sleep apnea first as many will quickly develop elevated Hgb/Hct levels after beginning TRT.
There is great potential for abuse. Patients will obtain scripts from more than one provider and if serum levels are not checked before refills this may go undetected. Also since testosterone is a controlled substance, should it not be reported when prescribed, much like other controlled substances?

Lynne @

How about carcinogenicity

farouq @

Finding it confusing? This shows that one needs to know how to read the medical reports and critique the quality of reviews e.g. RCT vs observational, sample size, delivery methods, compounded vs manufactured product. Only then when one applies their magnifying lens can they make sense of it all! Great information!!! Makes complete sense!!

Kayla Olusola @

This is misleading as synthetic T differs greatly from bio identical T. Fabulous results in overall health benefits in men and women with bio identical testosterone.

Diane @

Question - are other modalities of testosterone delivery less likely to cause non-calcified coronary artery plagues?

Thomas @

Highly confusing information
Hard to really believe

Dr Rishad @

No mention of higher risk for thrombus,be raised,stroke...how much testosterone?and what are the levels to begin therapy with free testosterone,totalT and bound T?


All of the medical literature these days is mostly nonsense. You cannot believe a thing you read anymore. For decades we believed that saturated fats caused coronary artery disease, until, a couple of years ago, the Institute of Medicine finally admitted it could find no data to confirm that. I did not review the above conflicting articles, but I would bet that the positive ones have conflicts of interest lurking somewhere in the background.

Charles @

Ditto! Ditto! Amen! Medical literature these days is so biased by ....follow the money.

Gayle @

So use of helps lower CV risk, but also increases coronary artery plaque volume - well...what?

Arthur @

I think it's replayed to delivery system. I prefer injectable over topical.

Matthew @


Matthew @

Says it's good, says it's bad no help for anybody

omar @

Totally confusing!


Totally confusing!


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