Dispelling testosterone myth - doesn't fall over 40 in health men

Dispelling testosterone myth

The Australian Financial Review
PUBLISHED: 07 Jun 2012 00:02:51 | UPDATED: 07 Jun 2012 05:16:15
by Jill Margo
 

 

 

Conventional beliefs about testosterone are about to shift. Landmark Australian research has shown that this vital male hormone does not inevitably decline as men get older.

Rather, it shows men who keep in excellent health can maintain unchanging levels of testosterone production well into old age.

If and when testosterone does drop, the decline is usually due to an accumulation of chronic disorders such as obesity, diabetes and cardiovascular disease rather than age itself.

This new picture of the natural history of testosterone is good news and is an incentive for men to be diligent about maintaining their general physical health.

The conventional view was that from 40 to 50, male testosterone levels began to drop by up to 1 per cent a year. It seemed there was nothing men could do to stop it.

Now researchers from Sydney and Melbourne have published a study in a major international journal showing “no decrease associated with age” among men over 40 who report maintaining very good or excellent health.

The Healthy Man Study published in Clinical Endocrinology, followed 325 men who reported being in excellent or very good health. This included taking morning blood sample nine times over three months.

While being obese or being an ex-smoker reduces testosterone levels, and fasting overnight increases levels the next morning, there were no effects of age itself.

Sydney’s ANZAC Research Institute director David Handelsman, an international authority on androgens, was the lead investigator of the study which may modify how testosterone is thought about and used clinically.

At present, rather than treating the conditions where testosterone production is deficient due to diseases of the reproductive system, testosterone is being inappropriately used as a kind of tonic for ageing. It is being used to treat the consequences of unhealthy ageing, without improving the underlying causes.

This week Handelsman also published a review of patterns of testosterone prescribing in Australia over the last two decades, showing how it is being overused.

His review, in the Medical Journal of Australia, suggests overuse is commercially driven and Australia’s PBS prescription criteria, introduced in 2000 as a world first, is being evaded. He calls for a tightening of criteria and monitoring of compliance.

Although Australian men are not the biggest consumers of testosterone, he says their use is among the highest and has been growing over the past two decades.

It began to rise steeply after 2006 when two new products, a gel and a slow-release injection, hit the market. He says this coincided with publication of “soft” northern hemisphere clinical guidelines that tacitly encourage overprescribing of testosterone for older men.

The survey showed great differences in use across Australia (see box below). Queensland was the highest consumer, with more than 16,000 doses a month per million of population compared with about 6000 in Tasmania.

So why are men seeking and getting access so easily to testosterone when not justified by any proven benefits?

“There are many myths about the powers of this hormone to boost flagging sexual function or act as an anti-ageing panacea and doctors are often no different to anyone else when it comes to the uncritical acceptance of such wishful thinking and folklore.

“A small group of doctors are androgen abusers themselves and prescribe testosterone and other drugs of abuse to other body builders too,” Handelsman says.

But is it detrimental to their health? “Given in proper doses to men who have genuine deficiency, it is not harmful. But among older men who do not have reproductive system diseases causing a genuine testosterone deficiency, the risks of accelerating cardiovascular or prostate disease remain without any corresponding benefits. Younger androgen abusers such as bodybuilders tend to use excessive doses and risk dangerous episodes of hypomania.

“Overall, it is just poor medicine to prescribe a drug someone doesn’t need,” he says.
And what does it cost Australia?

He says it is wasting tax dollars in the PBS. A company called IMS, that provides national sales data by pooling hospital and pharmacy figures, has shown $16.3 million is spent annually on testosterone replacement therapy. This does not include sales by compounding chemists of costly testosterone products with untested efficacy or steroids bought in the gym or illegally imported via the internet.
The pharmaceutical industry makes large profits, given steroids such as testosterone are now very cheap and constitute only 1 per cent of the marketed cost of the drug. In addition, Handelsman says the rising prescription rates are due to individual zealots and single-issue clinics promoting testosterone.

Large doses of testosterone do build muscle mass but don’t rejuvenate an ageing man’s sexual function. Yes, they boost libido but do nothing to help the mechanics of erectile function.
“Boosting libido in a man with failing erectile function – and doing nothing for this function – could be considered a form of mental cruelty.” says Handelsman.

This week the MJA published an article on how some companies tried to boost sales with “disease-awareness campaigns”.

These campaigns tended to exaggerate disease risk and prevalence and also misrepresented the effectiveness of treatment, according to the article’s co-author, Agnes Vitry, from the University of South Australia.

Although direct-to-consumer advertising is prohibited in Australia, they sidestep this through unbranded promotional campaigns which feature a condition treated by the manufacturer’s product and encourage viewers to ask their doctor about a newly available treatment.

Vitry described this as disease mongering and called for stricter limits on the role of drug companies in providing health information to the public because of the inherent conflict of interest.

The Australian Financial Review

Jill Margo

Jill Margo writes about men’s health from our Sydney newsroom.