Monday, June 27, 2011

My Doctor Will Not Give me Testosterone Replacement. Why?

My Doctor Will Not Give me Testosterone Replacement. Why?
Dr Andrew Rynne.

Doctors around the world still remain sceptical about the value of testosterone replacement therapy (TRT) for certain men. They remain very sceptical against a backdrop of ever mounting good peer review clinical evidence showing that TRT has the capacity to greatly improve older men’s quality of life and indeed maybe even extend their life expectancy.
These doctor’s objections to TRT for older men may spring more from their emotions rather than from their intellect. Here are just some or their erroneous arguments and why I think they are wrong.
(1) The Women’s Health Initiative  Study, published in 2002, showed that HRT was dangerous. This is a felonious argument on several fronts. First of all what this study actually showed was that Progesterone/Oestrogen combination increased the incidence of breast cancer in women by eight cases per annum per ten thousand women so treated.  Secondly, it is nonsense to extrapolate from that which might be true for women in HRT to men taking Testosterone Replacement. At best that’s emotional, not scientific.
(2) Falling levels of testosterone is part of the ageing process and its consequences are natural. Here is another classic for you. Osteoarthritis of the hip is also part of the ageing process and its consequences are natural. But is anyone seriously suggesting that we should not treat osteo of the hip?
(3) Testosterone Replacement Therapy might raise the incidence of prostate cancer. First of all there is not a shred of clinical evidence that this is the case. And secondly, cancer of the prostate is NOT a disease of younger men with high levels of testosterone. It is a disease of older men with low levels of testosterone. If anything then, testosterone might be protective against prostate cancer but I am not making that point here.
(4) Testosterone might fan the flames of an existing, yet to be detected, prostate cancer. This fallacy comes from confused thinking. Because by removing all testosterone you can bring about a temporary remission in prostate cancer, therefore by adding testosterone you might make matters worse. This type of logic, if even logical it is, is called a corollary. Corollaries may work like a dream in religion or philosophy but have no place in science or in clinical medicine.

Doctors waffling on about the “dangers” of TRT are forever preaching to the rest of us about Peer Review and Evidence Based Medicine.  They usually do this from the high moral ground of academia. And yet when it comes to ignoring their own advice, they seem to show very few qualms indeed.
This might be funny if it were not also quite tragic. We now know that TRT has many potential life enhancing and indeed life giving properties. The evidence for its value it treating the metabolic syndrome is emerging every day in new clinical trials. And yet so many of my colleagues are still with the dinosaurs.   

Doctor Andrew Rynne