Testosterone Hysteria: An Interview with Abraham Morgentaler, MD – Part 1

Screen Shot 2015-03-31 at 4.46.18 PMOpen any paper, browse the Internet or turn on the television and you’ll see the latest scary news on testosterone (T). A new rat study links T to prostate cancer. Several new studies purport to link testosterone replacement therapy (TRT) with a higher risk of having a heart attack or stroke. An advisory committee to the FDA expressed concerns about T overprescribing and fears of heightened risk for a cardiovascular event (CVE), suggesting tighter restrictions. Class action lawyers wasted no time in filing CVE lawsuits for over 300 TRT plaintiffs, and the case is now combined as a multi-district litigation in federal court in Northern Illinois. Like circling sharks, my legal brethren are already trolling for prostate cancer plaintiffs based on the new rat study.

If you’re on TRT, or thinking about it, should you be alarmed? Terrified? I asked Dr. Abraham Morgentaler, the Director of Men’s Health Boston and an Associate Clinical Professor of Urology at Harvard Medical School. He’s “the man” when it comes to T. This guy is probably the world’s foremost expert on men’s sexual and reproductive health and is known for his research and scientific writing on TRT. At a time when T hysteria dominates mainstream discourse, who better to help set the record straight?

Q: Testosterone is under fire these days. Why do you think there’s such a backlash in the medical community against TRT?

A: Testosterone use elicits a remarkable degree of passion, especially among those opposed to it.  Some of this appears to be a reaction against over-the-top claims by supplement providers and anti-aging enthusiasts, some is barely disguised antipathy against the pharmaceutical industry, and I believe a lot of it comes from individuals who are anti-sex. A similar story played out in the recent past with women and sex hormones also, where a very small reported risk in a highly publicized study (the Women’s Health Initiative) caused a dramatic shift in our treatment of women with menopause that was never scientifically based.

Q: Sounds like “hormonophobia,” as you’ve called it. Let’s talk about men’s hearts. What are your thoughts on the recent JAMA study linking TRT with increased heart attacks and strokes?

A: The JAMA study reported that a group of testosterone-deficient men that received T prescriptions had 29% more CVE’s (heart attack, stroke, or death) than a similar, untreated group. This study has already undergone two major corrections.  Troublingly, neither the authors nor JAMA editors disclosed that the actual percentages of individuals that experienced an adverse event was lower by half in the T group, and that the researchers’ conclusion was derived from a brand-new, statistical methodology that has never been validated.  Even more concerning was that the authors subsequently reported errors in their data that involved more than 1000 individuals, and discovered that nearly 10% of the “all-male” population was actually women! Due to these errors, more than 160 of the leading testosterone experts in the world, as well as 29 medical societies, have called for retraction of this article, asserting that “the data are no longer credible.”

Q: Sounds like bad science. What about the highly-publicized study by Finkle et al., claiming higher CVE risks for men over 65 or with a history of heart disease? I wrote a column on it a few issues back, showing that the CVE risk for men under 65 with no history of heart disease was the same as the risk for such men not on TRT — and that the “absolute” risk for both groups was well under 1%.  What’s your take?

A: The article by Finkle et al. was scientifically unsound. It compared heart attack rates for two periods of time that are unrelated.  One is how often physicians prescribed T to men with a recent heart attack, and the second is the actual rate of heart attacks in men that received a T prescription. It shouldn’t be a surprise that physicians were reluctant to prescribe T to men just recovering from their heart attack. In any case, in both groups, and for all ages, the actual rates of reported heart attacks were substantially lower than what is expected for that population.

Rick Collins, JD, CSCS [www.rickcollins.com] is the lawyer that members of the bodybuilding community and nutritional supplement industry turn to when they need legal help or representation. [© Rick Collins, 2014. Adapted from Rick’s column in Muscular Development magazine. All rights reserved. For informational purposes only, not to be construed as legal or medical advice.]