The American College of Physicians (ACP) just released (January 7, 2020) new guidelines on testosterone therapy that was published in the Annals of Internal Medicine (1). The authors stated, “The ACP Clinical Guidelines Committee based these recommendations on a systematic review on the efficacy and safety of testosterone treatment in adult men with age-related low testosterone. The target audience is all clinicians and adult men with age-related low testosterone.”
It sounds like the ACP studied the issue thoroughly which should lead to reasonable recommendations for physicians to follow.
In a perfect world, that’s how it should be. However, this a far from perfect world.
Recommendation 1a: ACP suggests that clinicians discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual function (conditional recommendation; low-certainty evidence). The discussion should include the potential benefits, harms, costs, and patient’s preferences.
I have no problem with Recommendation 1a.
Recommendation 1b: ACP suggests that clinicians should reevaluate symptoms within 12 months and periodically thereafter.
I have a lot of problems with this recommendation. Recommendation 1b is a perfect example of BAD MEDICINE.
Recommendation 2: ACP suggests that clinicians not initiate testosterone treatment in men with age-related low testosterone to improve energy, vitality, physical function, or cognition (conditional recommendation; low-certainty evidence).
Oy vey! This is a BAD recommendation.
Folks, I have been using testosterone therapy for nearly 25 years. Rebalancing testosterone levels in men and women can provide positive, life-changing benefits. I have seen testosterone therapy lower elevated cholesterol levels, treat depression and mood disorders, improve vitality and muscle strength as well as improving cognition in many of my patients. So, there goes Recommendation 2.
I first wrote about testosterone therapy in 1998 in my book, The Miracle of Natural Hormones, where I wrote about my father’s story. My father, Ellis, suffered with heart disease. He had his first heart attack at age 40 and a second one at age 42. After two bypass surgeries and a few angioplasties, he was on 12 different medications to treat persistent angina (20 years), diabetes and high cholesterol levels. When I learned about holistic medicine, the first hormones I learned about were thyroid hormone and testosterone. I found there was a wealth of research showing a correlation between low testosterone and/or thyroid hormone levels and the development and progression of heart disease. The first natural hormones I prescribed were for my father—natural testosterone and thyroid hormone. Within seven days of starting these hormones, his 20-year history of continual angina melted away—and did not return. Thirty days later, his cholesterol level which was always over 300 mg/dl, fell to below 200 mg/dl without changing his bad habits. And, most importantly, he looked and acted better. He reported (and I saw) his mood and brain function improved. Since that time, I have researched and utilized natural hormonal therapies with great success for my patients.
I have successfully used testosterone therapy in many other patients and seen positive results in every parameter mentioned in Recommendation 2.
As for Recommendation 1b, as I previously stated, it is a perfect example of what is wrong in medicine. Waiting 12 months to reevaluate a patient on any hormonal therapy is ridiculous. With testosterone, one of the adverse effects that needs to be monitored is the hemoglobin and hematocrit. Testosterone can cause the bone marrow to produce red blood cells. Too many red blood cells can make the blood thick and more likely to clot. This can lead to an increase risk in strokes and heart attacks.
The authors of the ACP study cited 38 randomized studies looking at testosterone therapy and various outcomes. The authors did not find compelling evidence that testosterone therapy increased cardiac events or deaths. In fact, the ACP study reported that testosterone therapy resulted in 3.75-fold lower risk of cardiac-related deaths as compared to subjects treated with placebo. Where was this lowered death rate mentioned in the final guidelines?
Testosterone therapy as part of a holistic health program that balances the entire hormonal system as well as corrects nutrient deficiencies can provide very satisfying results. In fact, this holistic approach can provide fantastic health changes. I see the positive results every day in my practice.
These are the benefits of testosterone therapy that I wrote about in The Miracle of Natural Hormones. The benefits include: improving osteoporosis, improving the symptoms of diabetes, increasing a general sense of well-being and improving libido and sexual functioning. In addition, testosterone can decrease negative mood parameters including anger, irritability, nervousness, and tiredness. Testosterone has been shown to prevent and treat coronary artery disease and improve and treat autoimmune disorders such as lupus and rheumatoid arthritis. Also, it has been shown that testosterone has the ability to rejuvenate muscle mass.
What do I think of the ACP 2020 guidelines on testosterone therapy? Fugetaboutit!! I could use stronger language here, but the point is made.
You don’t have to settle for subpar health. It is impossible to have optimal health when your hormones are imbalanced.
More information on bioidentical, natural testosterone and other adrenal and sex hormones can be found in my book, The Miracle of Natural Hormones.
If you need your hormonal system evaluated and balanced, please see one of us at The Center for Holistic Medicine.