Further research is needed to determine the risks and advantages of testosterone supplementation for older men, according to an article published in the Medical Journal of Australia.
Professor David Handelsman, Director of the ANZAC Research Institute at Concord Hospital, University of Sydney, reviewed two recent research articles on prescribing testosterone for older men.
AdvertisementOne of the reviewed research articles reported the European Male Ageing Study into the relationships of nonspecific physical and mental symptoms to serum testosterone levels, the results of which have been interpreted in a way that is likely to encourage testosterone usage in older men. The second article reported the early termination of a clinical trial for excess adverse cardiovascular effects associated with testosterone supplementation, and discourages the use of testosterone.
Prof Handelsman said that, taken together, these two studies could be construed as pressing the accelerator and the brakes at the same time on testosterone prescribing for older men ... with probably the usual effect of spinning wheels. However, several reflections arise for Australian clinical practice.
"Australia's national guidelines for testosterone use, developed in 2000 and adopted by the Pharmaceutical Benefits Scheme as the criteria for subsidised testosterone prescriptions, are vindicated," Prof Handelsman said.
"They aim to restrict testosterone prescribing for age-related androgen deficiency without hindering it for pathologically based androgen deficiency.
"The European Male Ageing Study definition of 'late-onset hypogonadism', which is reliant on a single measurement of serum testosterone, is not suitable for implementation in practice.
"Serial serum testosterone levels in older men are sufficiently variable to require the results of at least two blood samples taken weeks apart to establish a sustained low level of serum testosterone.
"It is evident that bans need to be reinforced on direct-to-public advertising of testosterone supplementation.
"Without this protection, an avalanche of misguided testosterone prescribing awaits us.
"Testosterone prescribing for older men is best restricted to clinical trials where ethical oversight ensures appropriate design and warnings to participants.
"Age alone may not prove a valid indication, but this should not limit essential further research within the framework of placebo-controlled clinical trials aiming to define the benefits and risks of testosterone use in patients with the comorbidities of aging, such as obesity, diabetes, metabolic syndrome, and other chronic conditions."
The Medical Journal of Australia is a publication of the Australian Medical Association.