having cardiovascular examination and echo

HRT: Does It Even Work?

Does Testosterone Even Work?
Has everyone been noticing that HRT is under an all-out, full frontal assault? The latest studies to do so are from a researcher named Dr. Matt Spitzer, located in the good state of Massachessetts, and the conclusion from his studies (and another out of Massachusetts) are essentially the following:

  • 1. PDE5 Inhibitors are just as good as testosterone (HRT).
  • 2. Testosterone is poorly understood and likely dangerous.

If you put these #1 and #2 together, the conclusion is obvious: just use drugs! That’s right: Viagra and Cialis are the answer.  Don’t believe me?  Check out what he and his coauthors wrote:

“In cohort studies, testosterone levels are associated weakly but consistently with muscle mass, strength, physical function, anaemia, BMD and bone quality, visceral adiposity, and with the risk of diabetes mellitus, coronary artery disease, falls, fractures and mortality. However, the clinical benefits and long-term risks of testosterone therapy especially prostate-related and cardiovascular-related adverse events have not been adequately assessed in large, randomized clinical trials involving older men (defined as age >65 years) with androgen deficiency. Therefore, a general policy of testosterone replacement in all older men with age-related decline in testosterone levels is not justified.” [1]

Now look at how curious his position is.  He basically admits that HRT should help men with diabetes and heart disease and should even improve mortality rates.  Now in my book, Low Testosterone by the Numbers, I show how testosterone therapy has reversed every condition that Dr. Spitzer lists and some more as well.  There is research that it can partially regress diabetes and insulin resistance, unharden arteries, improve osteoporosis, help men lose weight – the list goes on and on.  At the clinic where I can my HRT, they have found that they have gotten virtually every type II diabetic man off of his insulin!  So how can HRT not be a net positive for most men, considering that most of them are likely struggling with Metabolic Syndrome (prediabetes) or diabetes?  HRT clearly helps with almost all of the major killers of us guys.

And, again in my book, I discuss how testosterone helps with many of the huge issues that can make a big difference for us guys on a practical level:  decreasing depression, improving venous leakage and boosting libido.  Many, many guys on the Peak Testosterone Forum can also tell you how testosterone therapy cleared out their “mental fog”, got rid of crippling fatigue, greatly improved sleep and made them feel human again.

So then why would he conclude that HRT should not generally be given to men with androgen deficiency?  Well, he explained his reasoning with the following:

  • 1.  Potential prostate issues
  • 2.  Potential cardiovascular issues

First of all, all the major studies have shown that HRT does not increase prostate cancer risk in any cohort that they have looked at.  Now there may be some special circumstances where it does increase risk.  Never say never, eh?  I know I don’t have a crystal ball and neither do any of the researchers.  However, good-sized, well done studies have been done and so far they are very positive.  And Dr. Morgentaler, also out of Massachusetts, has explained why:  according to his research testosterone only fuels prostate cancer near castrate levels.  If you want to read a great rebuttal and a fantastic piece of scientific investigative research, read his article entitled  Destroying the Myth About Testosterone Replacement and Prostate Cancer.

Now heart-related issues are a bit more problematic and the reason is that there have been two recent studies that show that HRT may cause some cardiovascular problems in men. Personally, I do not think the studies were well done and believe that time will show that most of the troubles occur from poorly run HRT as I discuss in my page on  The Recent HRT Class Action Lawsuits.  (One of the two CVD studies were also from Massachusetts.) It’s no secret to anyone that has done their homework that men on HRT need to have their estradiol and hematocrit / hemoglobin managed and they should be screened for rises in blood pressure.  None of these studies did that as far as I know.

WARNING:  It may be that the topicals have a unique cardiovascular risk profile as I discuss in my page on the Risks of Testosterone.  ZRT labs makes note of the fact that topicals greatly increase capillary and extremity testosterone and estradiol levels – something that does not happen with injections for example.  One of the studies that showed cardiovascular issues with HRT was exclusively topicals.

However, a caution is definitely in order:  there does appear to be good evidence that some men with clotting disorders may be at an increased risk from HRT and I discuss that on the same page. Thus, it is possible that certain heart patients and some men with hypertension and stroke risk factors need to be more carefully screened and/or monitored.

But to be quite blunt, why would you take HRT away from the majority of men who have no such risk factors?  I simply do not see the logic in this.  My blood pressure is good; I have no cardiac arterial plaque; I have no known kidney issues/ and I was clearly greatly helped by exogenous testosterone.  So why would Dr. Spitzer argue that guys like me should not have testosterone until more study work is done?

Well, here is where it gets even more interesting.  Dr. Spitzer takes his argument one step further and has done a couple of studies that try to show that Viagra can do most of what testosterone can and that testosterone is essentially an unneeded add-on therapy.  Let’s look at a couple of his studies:

1.  Erectile Dysfunction.  A group of middle-aged and senior men with erectile dysfunction were put on Viagra and, in general, they improved of course.  Then Dr. Spitzer put half of them on HRT and half on a placebo.  The results?  HRT did no better than the placebo. [2] The conclusion is that you can just put men on Viagra and you really don’t need HRT, right?  Well, more about that later.

2.  Mood.  From what I can tell, Dr. Spitzer used the same study participants and basically used the same basic methods and design but this time looking at mood and “sense of well-being.”  [3] Again, what he found was that HRT offered no real improvement in mood over what the Viagra did.  The conclusion was clearly intended to be that you can just put men on Viagra and you really don’t need HRT.

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I don’t know whether Dr. Spitzer is going to try to continue with similar studies that basically try to discredit the need for HRT, but let’s step back and go to the most fundamental question:  is it heathful to restore a man’s hormones to physiological, youthful levels?  This question is clearly what is being ignored here.  For example, we know that increasing testosterone will add some muscle and decrease some body fat in most men.  Is not this an excellent anti-aging strategy?  We also know that HRT will lower most men’s insulin levels and thus give him greater blood glucose control.  Is not this also an excellent anti-aging strategy?  We also know that HRT will usually unharden arteries and activate eNOS, the all-important enzyme responsible for arterial nitric oxide.  Is not this an excellent anti-aging strategy?

Dr. Spitzer is an endocrinologist I believe and, as such, he has undoubtedly prescribed insulin to many of his diabetic patients when they lost their ability to produce insulin.  And, as an endocrinologist, he has also surely prescribed thyroid hormones to his patients that were hypothyroid.  So why would you not do this for your men that are hypogonadal and miserable with the symptoms of low T?  What is the difference?

The difference is simply that, for reasons I simply do not understand, there is an incredible bias among most endocrinologists against testosterone therapy.  I can tell you from practical experience on the Peak Testosterone Forum that endocrinologists are by far the most reluctant to give a man testosterone.  And I have seen this repeatedly regardless of the country.

And let’s go back to the Viagra-Makes-HRT-Unnecessary theory.  First of all, these medications are rife with side effects and you can become dependent and resistant to them.  See my Viagra and Cialis Summary for details. And, just as important, many men are not responsive to PDE5 Inhibitors. [4][5][6][7] That’s right – these magic pills just don’t work for some guys. And guess what? There are a number of studies that show when you add HRT on top of the PDE5 inhibitor, their erectile dysfunction is improved. So HRT is clearly helpful in the rather large subset of men where Viagra and Cialis just do not work or work minimally.

REFERENCES:

1)  Nature Reviews Endocrinology July 2013, 9:414-424, “Risks and benefits of testosterone therapy in older men”

2) Ann Intern Med, 2012, 157(10):681-691, “Effect of Testosterone Replacement on Response to Sildenafil Citrate in Men With Erectile Dysfunction: A Parallel, Randomized Trial”

3) Andrology, May 2013, 1(3):475 482, “The effect of testosterone on mood and well-being in men with erectile dysfunction in a randomized, placebo-controlled trial”

4) The Journal of Sexual Medicine, Jan 2011, 8(1):284 293, “Hypogonadal Men Nonresponders to the PDE5 Inhibitor Tadalafil Benefit from Normalization of Testosterone Levels with a 1% Hydroalcoholic Testosterone Gel in the Treatment of Erectile Dysfunction (TADTEST Study)”

5) Andrologia, Apr 2006, 38(2):61 68, April 2006″Testosterone and erectile function in hypogonadal men unresponsive to tadalafil: results from an open-label uncontrolled study”

6) The Journal of Urology, Aug 2004, 172(2)658-663,

“RANDOMIZED STUDY OF TESTOSTERONE GEL AS ADJUNCTIVE THERAPY TO SILDENAFIL IN HYPOGONADAL MEN WITH ERECTILE DYSFUNCTION WHO DO NOT RESPOND TO SILDENAFIL ALONE”

7) Urology, Mar 2006, 67(3):571-574, “Adjunctive use of AndroGel (testosterone gel) with sildenafil to treat erectile dysfunction in men with acquired androgen deficiency syndrome after failure using sildenafil alone”

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