It’s MOvember!

I’ve been supporting the Movember movement for the last several years, in part because it’s always fun to grow a moustache, but more importantly because it raises awareness of men’s health issues including prostate cancer, testicular cancer, and mental health. I do a lot of work with hormone replacement therapy for both men and women, which always includes discussions around cancer prevention as well as mental and sexual health.

For my male patients, two very important issues are testosterone replacement and prostate health. To be clear: there is no correlation between testosterone replacement therapy and prostate cancer1. To do testosterone replacement properly however, one needs to have a complete regimen dealing not only with improving the low testosterone levels, but also controlling for excess conversion to both estrogen and dihydro-testosterone. Too much estrogen in men can cause an increase in belly fat, stimulate the growth of breast tissue, and cause mood instability. Too much dihydro-testosterone can cause prostate enlargement and hair loss. Testosterone replacement therefore requires careful monitoring and must be medically supervised.

In addition, there has been recent noise about the link between testosterone replacement and heart disease following a study by Vigen and colleagues published in 2013 in JAMA2. The truth of the matter is:

1. Low testosterone levels are associated with increased mortality, atherosclerosis, and coronary artery disease;

2. Mortality is reduced by one half in testosterone- deficient men who are treated with testosterone therapy, compared with untreated men;

3. Exercise capacity is increased with testosterone treatment vs placebo in men with known heart disease (angina, heart failure); and

4. There is uniform improvement in heart disease risk factors (fat mass, waist circumference, insulin resistance) with testosterone therapy vs placebo3

Multiple formulations of testosterone therapy are available, but symptomatic benefits might not manifest for several weeks. Concerns regarding cardiovascular and prostate cancer risks are not supported by current evidence. Clearly, testosterone therapy can be considered a safe and effective treatment for testosterone deficiency. For a thorough assessment of your hormone status, you can see your family physician or call my office directly. No referral is necessary.

If you wish to support my “Mo” this month, with all proceeds going to Men’s Health, donate at http://mobro.co/grantpagdin. Better still, join with me and grow your own Mo!

Your partner in Living Longer Better,

Dr. Grant Pagdin MD

Sources

• http://www.medscape.com/viewarticle/845705_5
• Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310;1829-1836.
• Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015;90:224-251.