Testosterone: A Fear-Fueled Debate
The effects of testosterone deficiency (also called "hypogonadism" or, informally, "low T") have been recognized for millennia. The treatment of hypogonadism has been described in medical textbooks for decades, and the symptoms are observed daily in medical practices across the country.
Still, the use of supplemental testosterone has always been controversial, perhaps more so today than ever before. Its ability to improve men's sexual symptoms, boost energy, and enhance well-being were quickly recognized after it was first synthesized in 1935. By 1941, however, it was reported that testosterone "activated" prostate cancer, inciting a fear among physicians that has persisted for more than 70 years.
Shockingly, the decades-old belief that testosterone therapy would precipitate rapid prostate cancer growth was based on uninterpretable results in a single patient! Yet this fear established a dominant narrative that was impervious to substantial evidence to the contrary.
As a testosterone researcher for nearly 40 years, and as a clinician for more than 25 years specializing in men's health, I have treated several thousand men with testosterone. Few topics in medicine elicit as much passion. Unfortunately, passion clouds our ability to assess the evidence on testosterone objectively.
The latest concern about testosterone is over potential cardiovascular (CV) risks. In March, the US Food and Drug Administration (FDA) issued a warning about testosterone's possible CV risks, and advised that testosterone therapy not be initiated for "age-related" symptoms.
The controversy is eerily similar to the one involving prostate cancer so many years ago—a rush to judgment based on the weakest of evidence. As the inimitable Yogi Berra might say, "It's like déjà vu all over again."