Jojy Cheriyan MD;MPH-January 30,2013

Pumping body with testosterone supplements has been a trend for several years among men of all age groups, even among teenage boys, to build muscle, to improve sexual function and athletic performance, and sometimes just for fatigue. Advertisements on Television and other mass media have led to enormous rise in testosterone prescriptions by doctors in recent years.

The new study published in PLOS One yesterday found that "taking testosterone therapy doubled the risk of heart attack among men over age 65 and nearly tripled the risk in younger men with a history of heart disease." Most of these men developed heart attack in the first 90 days of starting testosterone.

Last November a report in the Journal of the American Medical Association revealed exponential rise in the number of prescriptions for testosterone. The report said doctors wrote more than 5.3 million prescriptions for testosterone therapy in 2011, which was five times as many as in 2000.

Another study published in JAMA Internal Medicine found that the number of men taking testosterone tripled from 2001 to 2011, and 4% men in their 60's use testosterone. The researchers of this study also found that half of men in the study group were diagnosed with Hypogonadism and 25% of prescriptions were given without even testing the testosterone levels.

On the other side, studies have also shown that testosterone can improve sexual function, bone density, lean muscle mass and strength, while lowering cholesterol and insulin resistance. A 2012 study linked testosterone with a lower risk of death , and a 2013 study in the Journal of Clinical Practice linked testosterone to healthier cholesterol level (high HDL) , better blood pressure and blood sugar levels.

Medical community is in uncertainty , and divided with the new developments. Some experts say that the new study is not a randomized study and the finding that the heart attack occurred in a short period of 90 days is unlikely. Some say hormones are powerful and sometimes cause surprising effects throughout the body. Some experts link this to the Hormone Replacement Therapy in women, which was once found to prevent heart disease, but later became the culprit for heat attacks, stroke and breast cancer.

We need more evidence-based clinical trials to study the effects of testosterone supplements. Patients should open discussions with doctors that leads to proper diagnosis based on symptoms, lab tests and other health needs. Do not take testosterone based on misleading advertisements in health magazines, on internet or TV. Doctors should also encourage conversation, and use clinical judgment and ethical standards to avoid unnecessary prescriptions at the insistence of patients.

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