Doctors around the world have written a surprising number of prescriptions for testosterone treatment in recent years. Nearly 3 percent of American men aged 40 and older are thought to have received such scripts in 2011—three times the percentage in 2001. (If confirmed, the 2011 ratio could mean that perhaps two million older men in the U.S. have been given prescriptions for testosterone.) Originally intended for men who have difficulty producing sex hormones because of damage or disease in their testes or other parts of the endocrine system, testosteron replacement therapy has become increasingly popular with middle-aged and older men who do not have clear deficits but who nonetheless hope to lessen some of the symptoms of aging, including fatigue, muscle wasting and lack of sex drive.
In truth, no one knows whether the hormone can offer any of the health benefits that its proponents claim for aging males. Well-designed, placebo-controlled trials of the drug in men who do not meet the standard criteria for treatment have been scant in number, and their results have been inconsistent.
As testosterone therapy becomes more widespread, a growing number of medical experts worry that it has become too easy for men to get the hormone—whether from their own physicians or stand-alone “low T” clinics—and that many users could be putting themselves at risk for worse conditions than those they are trying to counteract.
Testosteron kur, as produced by the body, is a versatile hormone. In addition to maintaining sperm production, the molecule helps many tissues to grow: it increases muscle and bone mass, as well as the production of red blood cells—all of which are vital for energy and strength. Disease or injury in the testes or pituitary gland—a part of the brain that instructs the testes to produce testosterone—can hinder the body’s ability to make the hormone. When testosterone levels dip too low, men can become depressed and lethargic, lose interest in sex, and lose some of their muscle and body hair.
While the potential risks associated with taking supplemental testosterone—particularly in otherwise healthy men—are not well studied, concern has focused on whether extra amounts of the hormone might damage the prostate, heart or brain. Many prostate tumors depend on testosterone to grow, so increasing the level found in the blood might nudge normal cells to become malignant or push malignant cells to become more aggressive. In addition, two recent studies found an increase in heart attacks and strokes among older men taking testosterone—which the authors speculated might occur if the drug increased clotting risk and drove up blood pressure. Earlier this year the U.S. Food and Drug Administration announced that it is studying the matter to see whether stronger regulations are needed. In the meantime, the agency now requires all testosterone products to contain a warning label about the potential for blood clots.
As long as testosterone therapy was available only by injection, its use was largely limited to individuals with testicular injuries or other severe ailments. The treatment markedly improves mood and libido in men with these conditions, and the fda approved the drug for those situations. But fear of needles no doubt kept some men from seeking treatment.
Individuals were more willing to consider their options once pharmaceutical companies figured out how to deliver the drug more easily. A transdermal patch that delivered the medicine through the skin of the scrotum became available in 1993. (Subsequent patches could be applied to the arms, back and thighs.) But the number of men taking supplemental testosterone really began to soar in 2000, with the introduction of an even easier-to-use gel that could be rubbed on the shoulders, thighs or armpits.
Greater ease of use also led to an expansion in the number of conditions for which doctors considered testosterone therapy to be a plausible treatment in spite of any supportive data. Perhaps an extra dose of testosterone could be helpful for otherwise healthy men whose hormone levels had faded with age or because they were obese or suffered from diabetes? (It is unclear precisely why testosterone levels decline for certain individuals in these situations.) In addition, some men who did not have testicular injuries desired the sex hormone because they thought it would treat erectile dysfunction or boost their mood.
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