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Testosterone, The Biggest Men's Health
Craze Since Viagra, May Be Risky
by SARAH VARNEY
April 28, 2014
3:35 AM ET
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Men seek it out to combat low energy and decreased sex drive.
Prescription testosterone has become so popular that so-called 'low
T' clinics are becoming common sights in cities and suburbs.
The number of testosterone prescriptions written in the U.S. more than
tripled in the last decade. But researchers suspect that much of the
testosterone dispensed at low T clinics isn't tracked, since it's often
bought with cash. This unfettered flow of testosterone—officially a
controlled substance—has raised concerns among doctors who
specialize in hormonal problems.
In most doctor's
"In most doctor's offices, you don't see a big
“
offices you don't see
a big shingle over
their door saying,
'Get your
testosterone here!'
- Dr. Edward Karpman
shingle over their door saying, 'Get your
testosterone here!' " says Dr. Edward Karpman,
a board certified urologist and the medical
director of the Men's Health Center at El Camino
Hospital in Los Gatos, Calif. Karpman says low T
clinics aren't in the business of treating the
complex medical problems that often
masquerade as low energy and decreased sex
drive. Those can include sleep apnea, depression and, perhaps most
importantly, heart disease.
"Any man who presents, especially in his 40s and 50s, with new onset
erectile dysfunction is at an increased risk for cardiovascular disease
and even heart attack or myocardial infarction," says Karpman.
Hormone treatment itself isn't without risk: a recent study of more than
55,000 men found a doubling of heart-attack risk among older men
who used testosterone. Younger men who had a history of heart
disease had a higher incidence of non-fatal heart attacks. In addition,
men who are on prolonged high-level testosterone replacement
therapy can experience testicular shrinkage.
Shots - Health New s
Popular
Testosterone
Therapy May Raise
Risk Of Heart Attack
Yet even as calls for closer scrutiny of the
treatment intensify, the clinics continue to draw in
men like Greg Lucas. At 25, Lucas was single
and a rising star at a Dallas software company.
But he didn't quite feel right – his energy, his
sleep, his libido were all lagging. He was having trouble managing his
weight, too.
His symptoms sounded a lot like those described in an ad for low
testosterone. So Lucas decided to do what the ad recommended: talk
to his doctor.
"His first response was, 'OK let's do a blood test and see where you're
at,' " recalls Lucas. "Following that, my blood test returned a rating that
was in the normal range for the lab and he said that was fine."
Lucas protested: His levels, after all, were in the bottom 5 percent of
normal – that seemed out of step for a 25-year-old man. Lucas was
seriously overweight, and his doctor advised him to diet and get more
exercise.
The problems persisted, though, and Lucas pressed his doctor for the
next three years or so about testosterone treatment. Each time, got
the brush off.
Lucas did manage to start exercising at a gym, but he wasn't losing
much weight. Then a coach mentioned that testosterone treatment
could be the answer to his mothballed mojo and suggested he get a
second opinion at a low T clinic. He went online and ended up calling
a clinic in Dallas. He was impressed. Finally, it seemed, someone
was listening to him.
Shots - Health New s
Test First Before
Going For Those
Testosterone
Supplem ents
"They did a blood test and found my testosterone
level to be even lower that the last time I had it
tested, and they said, 'We would absolutely
recommend that you start treatment right away,' "
Lucas says.
Lucas says the testosterone therapy changed his life: he lost weight
and got his energy back. He only wishes that his regular doctor would
treat him for low T, so that his insurance would cover the bills.
Despite Lucas's positive experience, the risks and health benefits of
long-term testosterone therapy are not well understood. The Food and
Drug Administration is reassessing the safety of testosterone
products. A spokesperson reiterated the agency's own guidelines:
None of the products approved by the FDA should be prescribed
unless low testosterone is associated with a medical condition.
Some doctors warn patients to stay away from low T clinics. Dr.
Bradley Anawalt is one of those doctors. He heads the Hormone
Health Network, part of the professional association for
endocrinologists which has released clinical guidelines for
testosterone therapy.
Anawalt calls the low T clinics "sex hormone factories" which promote
all the potential virtues and great myths about how testosterone may
solve all problems. "They're really out to prescribe as much
testosterone as they possibly can, and it's not clear that all these
practices are completely safe," he says.
But there's also no evidence the clinics are not safe. State medical
boards typically investigate only when patients file complaints, and
there hasn't been an outpouring of accusations against the clinics. But
a review of physicians working for a number of low T clinics found that
very few specialized in urology or endocrinology. Instead, one doctor
at a Chicago clinic and another in Fort Lauderdale were
anesthesiologists; in Houston, an allergist; in Phoenix, an osteopath;
and in Washington, D.C., an obstetrician-gynecologist.
"There is some hope that state or federal governments will start to
crack down and regulate unscrupulous prescription of testosterone to
men, and perhaps they will review the practices of these clinics," says
Anawalt.
“
We don't just see a
patient and say, 'Hey,
here your go. Here's
some testosterone.'
- Dr. Bill Reilly
The clinics themselves say they're legitimate
medical practices. Dr. Bill Reilly is the chief
medical officer at Low T Center, one of the
largest chains of low T clinics, based in
Southlake, Texas. His company has 45 offices
and some 35,000 patients. Reilly says patients
must have a diagnosed medical condition.
"Our number one complaint at Low T is, 'Why won't you treat me?' We
just don't see a patient, 'Hey, here you go. Here's some testosterone,'
" Reilly says. "They go through a complete history, physical, thorough
evaluation. We go through their symptoms."
Reilly says some 15,000 men have been turned away from his clinics
with no treatment because they don't meet the medical definition of
low testosterone. And those with sleep apnea or high blood pressure
or other serious illnesses are encouraged to see their family doctor.
Before joining Low T Center, Reilly was a joint surgeon. He doesn't
believe medical training in urology or endocrinology is necessary to
do the job well.
"You don't need to be an endocrinologist. You don't need to be a
urologist," says Reilly. "We're all doctors. And we study more about
testosterone than they do. We basically follow the national
endocrinology guidelines."
Reilly says the growing criticism from others in the medical community
is perhaps just ignorance and fear of competition. After all, Low T
Center expects to more than double its number of sites in the next
year, reaching perhaps as many as 70,000 patients.
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