Testosterone Trials Show Limited Benefit In Older Men

Testosterone therapy in men over 65 has mixed effects, according to a large review funded by the National Institute on Aging (NIA)

As men get older testosterone levels commonly drop, but whether this is simply a byproduct of the aging process or actually harmful to health is still somewhat debatable. In any case, just as hormone replacement therapy has proved popular and frequently beneficial in women, testosterone therapy has risen in popularity with men. In an effort to determine whether this actually has any beneficial effects, a study of 720 men aged above 65 has been carried out in the US. This involved participants receiving a topical testosterone gel, or a placebo gel, for up to 12 months.

“A number of older men have testosterone levels below those found in healthy younger men. In most cases, these low levels are not due to diseases known to affect testosterone levels. Many of these men also have problems that could be related to low testosterone, including impaired cognition, anemia, cardiovascular disease, diminished sexual function, decreased mobility and fatigue. The T Trials were designed to determine if testosterone treatment might help alleviate these symptoms and conditions while monitoring for adverse effects”

The positive findings

52% of those patients with known anemia showed an improvement in red blood cell numbers, which appeared to improve energy levels and alleviate symptoms. Testosterone was also able to increase volumetric bone mineral density (vBMD), which is a good estimation of fracture risk. Although osteoporosis is a more prevalent problem in women, this finding may merit further study. 

The negative findings

While testosterone's benefits are wildly exaggerated by some figures, worryingly the trials found that noncalcified coronary artery plaque actually grew more in those men receiving testosterone. This was only determined from scans on 170 people and therefore requires additional research, but it remains a surprisingly and concerning finding. 

Testosterone also failed to show any cognitive benefit in men with age-associated memory impairment (AAMI), which is a form of mild memory loss separate from dementia. No significant differences emerged from the placebo and real gel group. 

We should of course be careful not to extrapolate this too much, but it does indicate that testosterone is far from universally beneficial and may in fact have questionable benefit. It certainly isn't a miracle drug, as some parties claim. 

“The results on diverse outcomes indicate the potential trade-offs between benefits and risks of testosterone treatment in older men. However, clarifying the effects of testosterone on many major clinical outcomes such as cardiovascular events, fractures, and disability will require longer, larger scale trials. The results also illustrate that decisions about testosterone treatment need to be individualized, taking into account each patient’s balance of risks for the various conditions that testosterone treatment could affect”

Read more at NIH News