Here we go again. Another cure-all drug, this time testosterone replacement therapy (TRT), is shown to have potentially life-threatening side effects, including heart attack or stroke, according to a recent report by Health Canada.
What's a busy family doctor to do?
Even now, TRT is heavily promoted. A spring in your step, satisfied partners, stronger bones and muscles, more ambition to get through your day – all of these are supposed to be part of the package of benefits of taking this hormone.
If truth be told, doctors largely bought into this mythical approach – a fountain of youth in a daily gel or a monthly injection; pills, patches or pellets to stay forever young.
But is aging itself a disease?
According to the strict medical labelling, testosterone is only supposed to be offered to men with true, blood-test-proven testosterone deficiency. We call that hypogonadism. This condition is usually found in patients with tumours, genital surgery, groin injuries or those on cancer chemotherapy.
Nowadays, of all the men taking testosterone, perhaps only 20 per cent actually deserve prescription TRT.
Like all good things, it is oversold: North American men purchase $2-billion worth of the stuff annually. In Ontario, according to a study by the Institute of Clinical Evaluative Sciences and St. Michael's Hospital, TRT prescriptions have increased by more than 300 per cent since 1997.
So who convinced doctors to so widely prescribe this hormone?
"I just feel like a man again," Wajid, 52, says about his TRT experience. Tell him the risks of the drug, and he protests. "I understand the problems, but I'm not going back to the way I was." Skimming quickly, he signs all my informed-consent forms, but will absolutely not give up his drug.
But is that what testosterone is for? Is "feeling like a man" enough to justify long-term medication?
It's not easy to answer. Baby-boomer men, and their partners, want it all: Health, wealth and perpetual sex – on demand, and at any age or with any number of accompanying illnesses.
To some extent, men have a point. We know that the body's natural testosterone starts to slowly decline around age 35. That's partly why men may slowly develop a mid-section gut, feel more aches and pains, have diminished interest in sex, give up sports and become grumpy old men before their time.
Before TRT came along, there wasn't much doctors could do for men who claimed to be going through male menopause, or andropause. Previous home-remedies included getting a new hairstyle, a new sports car or a new wife – not necessarily in that order. We call that T-supplementation – getting an external testosterone boost.
Eventually, industry advertisers let men know that they could obtain manhood artificially through pharmaceutical-grade medications. And the drugs do work. Any man will probably feel taller, stronger and longer if he's given testosterone, at least initially, whether he needs it or not.
That's the problem.
There are clinics across the country where almost any man who walks through the door is given TRT. Men are asked questions like: Do you want to build more muscle but can't? Do you have unrestful sleep? Do you have a shorter fuse and lose your temper more easily? Do you just not feel like exercising any more? Do you have mental fog?
What man doesn't occasionally go through such issues?
Answer yes to the prompting questionnaires, and immediately various MDs will automatically prescribe TRT. And the men do feel better, no mistake about it. It's like giving a depression pill to someone who's not depressed. With the artificial chemical boost, there may be a brightening of mood.
But that is a misuse and abuse of a powerful, long-term medication. Doctors need to return to basics. A proper history, physical exam and lab tests should be performed.
If TRT is medically warranted, so be it. And the risk of future complications must be monitored closely.
Testosterone is not a recreational, lifestyle-enhancement drug. It's not for the weekend, spring break or that trip to Vegas. From prostate cancer to blood clots, testosterone therapy may cause side effects, and should be used in the right patients for the right reasons.
Want to improve your testosterone levels? The single best advice is to exercise enough to get down to your ideal weight. Get rid of that belly fat.
Then go do the testosterone blood test, and discuss the findings with your doctor. But please, don't pressure your MD into prescribing TRT because your neighbour feels better on the hormone.