Should aging males use testosterone therapy to increase overall health and longevity? It’s a question I’ve pondered after interviewing Dr. Malcolm Crowthers, an early pioneer of testosterone therapy, in London, England, years ago. Now, Dr. Abraham Morgentaler, Clinical Professor at The Harvard Medical School, agrees the benefits of “big T” should not be denied to men, even those with prostate cancer. And would big T get me to 95 +, I wonder?
I vividly remember talking to Crowther’s patients. They were happy campers, hoping to be shot by a jealous lover at age 95!
But sex is only part of the big T story. Low testosterone is present in 40 percent of men over age 45. Its loss is associated with fatigue, depression, insomnia, grumpiness, lack of interest in sex and problems at work.
So Dr. Morgentaler asks why not prescribe testosterone. Critics have always argued that aging is a natural process so why medicalize it. This is a bit hypocritical since male doctors have no problem treating menopausal symptoms in women with female hormones.
Morgentaler makes another point. He says no one argues against treating patients with bad hearing, poor eye sight, sore hips or blocked coronary arteries, so why not help men with low testosterone? “Besides”, he adds, “normal aging stinks”. I say amen to that.
However, I, along with other doctors, have had a major concern with big T. For years we’ve feared that testosterone, particularly when prescribed to a man with undiagnosed early prostate cancer, might make the cancer grow, like adding gasoline to a fire.
But Morgentaler is convinced this is not the case. First, he says, an earlier study linking testosterone to cancer was wrong. Dr. Charles Huggins, a University of Chicago researcher, showed that when he castrated men with prostate cancer a chemical, acid phosphatase, decreased. But an injection of testosterone in males with this cancer triggered an increase in acid phosphatase. Huggins was awarded the Nobel Prize in Medicine and the theory was born that testosterone caused prostate cancer. But Morgentaler later discovered this conclusion was based on just a single patient!
Morgentaler subsequently published an article in the New England Journal of Medicine on the risks of testosterone therapy after reviewing 200 medical studies. He could not find any evidence linking high levels of testosterone to prostate cancer.
Morgentaler then decided to give testosterone to men suffering from the effects of low T. But to make sure they were free of cancer he performed biopsies of the prostate gland prior to treatment. To his surprise he found several cancers which showed low T was not protective against this malignancy.
Since this finding, he has reported, in the Journal of Urology, 13 cases of prostate cancer treated with testosterone for two and a half years. Biopsies showed none of the cancers have progressed. In fact, in 54 percent, biopsies could not find any trace of malignancy!
Morgentaler, ridiculed for his early research, is now not the only doctor who believes Huggin’s theory about testosterone was wrong. Namely, that low T is not protective against prostate cancer and high T is not the devil that triggers it. Recent studies in Germany and other countries show similar results.
Morgentaler no longer believes he’s making a pact with the devil when he prescribes testosterone. Rather, he’s convinced that low T is under recognized, underdiagnosed and undertreated and it does not make sense to deprive men of testosterone therapy when they have low T.
What struck my eye in researching this column was the finding that men who normally have high levels of testosterone live longer. But it is still not known if prescribing the big T to men with low levels will have the same effect.
This possibility has me thinking. In my 20s I considered 75 the ideal time to die and escape old age. But at 75 I had a change of heart. I aimed at 80, then 85, then 90. Now 90+ I’m still enjoying life and family. So why not 95?
Maybe it’s even time for a trip to Boston to see Dr. Morgentaler!