DOCTOR'S VIEW ARCHIVE

Testosterone Therapy for the Old Man?

Medical Authors and Editors: Barbara K. Hecht, Ph.D. and Frederick Hecht, M.D.

Jan. 29, 2004 -- Testosterone replacement therapy has been controversial in elderly men -- say, men over 65. Despite this controversy, testosterone supplementation has increased "substantially." There has been a rise of more than 500% in the prescription sales of testosterone products in the United States since 1993.

It has been full speed ahead, even if we don't know where we are going.

To try to make some scientific sense of the situation, The New England Journal of Medicine today has a critical review on the subject. The article considers data from 72 studies pertaining to the risks of testosterone replacement therapy.

The compendious (comprehensive but brief) review was prepared by Drs. Ernani Luis Rhoden and Abraham Morgenthaler from the Division of Urology at Beth Israel Deaconess Medical Center and Harvard Medical School. Neither author declared any ties to makers of testosterone products or other conflicts of interest

The Facts

Many studies have documented that the blood levels of testosterone in men decrease as they age. This decrease in testosterone in men occurs moderately and gradually over a period of several decades.

Unanswered Questions

One essential but still unanswered question is whether this decrease in testosterone with age is physiologic, perhaps conveying a benefit, or pathologic (abnormal), causing harm to men.