Endocrinologist examines benefits and harms of testosterone therapy

An article in the latest edition of Australian Prescriber looks at the prescribing of testosterone, often used for ‘male menopause’ symptoms such as reduced energy, poor concentration and increased body fat. Over the past decade there has been a steep rise in the amount of testosterone dispensed in Australia and globally.

Dr Donald Perry-Keene, endocrinologist at the Royal Brisbane and Women’s Hospital, examines the benefits and harms of testosterone treatment and raises concerns that testosterone is often being used when true hypogonadism (decreased function of the testes, in either testosterone or sperm production) is not proven.

Androgen deficiency may cause symptoms and signs such as decreased spontaneous erections, hot flushes, loss of body hair, low sperm count, osteoporosis and reduced libido. These men should be investigated but treatment with testosterone should not be based on testing alone. Primary and secondary causes of low testosterone should be identified. Therapy should not be commenced until two abnormal tests have been returned.

Prescribing testosterone for non-specific symptoms, such as those associated with ageing, is poorly validated and may be harmful. These less specific symptoms include decreased energy, depression, increased body mass index, poor concentration, reduced muscle bulk and sleep disturbance. There is little evidence that testosterone improves these symptoms.

“The concern is that testosterone therapy is being overused. When indicated, it is relatively safe in the short term at recommended doses. But it’s not without risk. Safety and adverse effects also need to be considered. Testosterone should not be given to men with prostate cancer, severe untreated sleep apnoea or prostatic symptoms. There is also inconsistent evidence regarding the risk of cardiovascular events in older men treated with testosterone,” says Dr Perry-Keene.

Dr Perry-Keene hopes that raising the issue of the need for long-term studies of the efficacy and safety of testosterone treatment in Australian Prescriber will encourage further testing and research.