April 30, 2014 in Nation/World

Physicians call for better testosterone research

UW doctor urges conservative approach
Melissa Healy Los Angeles Times
 

With nearly 3 percent of American men over 40 boosting their testosterone levels with a prescription supplement, the financial and public health stakes couldn’t be higher. But in increasing numbers, physicians are complaining that research on the safety of testosterone patches, creams and emollients is anything but conclusive, leaving doctors and patients alike uncertain about how and whether to treat a condition newly branded as “low T.”

In the wake of studies linking testosterone supplementation to increased heart attack and stroke risk, a physician writing in the respected British journal Lancet Endocrinology this week weighed in on the testosterone debate urging caution and more – and better – research.

“What, then, can older patients be told about the risks associated with testosterone?” asked University of Washington endocrinologist Dr. Stephanie Page in the Lancet on Monday. “Physicians need to admit they simply do not know and use conservative treatment guidelines to guide therapeutic decisions.”

Despite the advertising blitzes for testosterone products and “undoubtedly, some degree of over-prescription,” Page wrote that researchers must launch large clinical trials.

Over recent weeks, a group of physicians and medical organizations has called on the Journal of the American Medical Association to retract one of the studies that sounded alarms about testosterone treatment, charging that the authors’ conclusions were undermined by “gross data mismanagement.”

That study, published in JAMA in November, suggested that men who underwent an artery-clearing procedure and then took prescription testosterone medication were 30 percent more likely to suffer a heart attack, stroke or death from any cause than were similar patients who did not take testosterone.

In recent months, however, JAMA has published clarifications from the authors. Those have revealed that the study population was much smaller than that reported; and they acknowledged that the calculations of increased risk were based on statistically derived estimates, and not raw data. The raw data, in fact, suggested that those in the testosterone group actually were less likely to suffer a cardiovascular “event” than those who did not take testosterone.


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