MD Legal Muscle - Trashing Testosterone

Q: Do you think the backlash against testosterone replacement therapy will ever end?

A:Right now, there’s a lot invested into demonizing testosterone and its replacement therapy (TRT). Class-action lawyers, constantly trolling for plaintiffs, announced that 2,342 lawsuits were filed in the Multidistrict Litigation in Chicago regarding the “allegedly harmful side effects associated with testosterone replacement therapy supplements.” The lawyers often cite the U.S. Food and Drug Administration’s (FDA) Drug Safety Communication, which cautioned about using testosterone products for low testosterone due to aging, and required labeling changes to inform of a possible increased risk of heart attack and stroke. Critics of TRT harp on two areas: 1) the hawking of testosterone via direct advertising to consumers; and 2) the supposed increased cardiac risks of using the drug.

Regarding advertising, testosterone certainly isn’t the only drug being marketed on network television. One commercial used a former “America’s Next Top Model” to pitch a drug boasting 75 percent clearer skin for people with moderate to severe plaque psoriasis. While we watch her saunter from one elite photo shoot to the next, the announcer causally mentions that Stelara may increase your risk of infections and certain types of cancer. Then there was the commercial for Humira, which is good for rheumatoid arthritis but may increase your risk of getting lymphoma and other cancers— and may cause nervous system problems, blood problems, heart failure and new or worsening psoriasis (for which, I guess, you can take Stelara). Frankly, I think allowing Big Pharma to advertise any drugs directly to consumers is bad policy. The only two countries to permit the practice are the United States and New Zealand, as the rest of the world seems to wisely grasp that physicians should tell their patients what drugs would help them, not the other way around. But the point I’m making is that all drugs have side effects, including all the ones advertised on television, but only testosterone seems to be attacked.  

Regarding the supposed increased cardiac risks, both the methodology and conclusions of two recent studies claiming to link testosterone with heart problems have been challenged by medical authorities, including Muscular Development’s Dan Gwartney, MD. Harvard testosterone expert Abraham Morgentaler, MD, also rebutted this “testosterone hysteria” in the print edition of my “Busted” column in Muscular Development, observing that these studies run contrary to 40 years’ worth of research, and that accumulating evidence suggests that testosterone may even reduce the risk of cardiovascular events, not increase it. At least five studies that appeared after the FDA’s Safety Communication show little to no effect on cardiovascular health from TRT. These studies follow a half-dozen other recent trials, analyses and meta-studies contradicting the two studies that precipitated the FDA’s investigation.

In a retrospective study published online August 6, 2015 in the European Heart Journal, researchers looked at data on more than 83,000 male veterans with documented low testosterone (but no history of heart attacks or strokes), all age 50 or over, who received care between 1999 and 2014. The study divided the men into three groups: those whose testosterone levels were normalized through treatment, those who were treated but without reaching normal levels and those who were untreated and remained at low levels. Those who were treated and attained normal levels were 56 percent less likely to die during the follow-up period, 24 percent less likely to suffer a heart attack, and 36 percent less likely to have a stroke. At least for these men, TRT was very good for their hearts. [For the latest testosterone research studies, “Like” my page on Facebook and follow me on Twitter @RickCollinsEsq.]

So, what’s up with all the lawsuits? We can’t be sure, but just because you’re on TRT and you have a heart attack doesn’t mean the TRT had anything to do with it. Millions of men have had heart attacks, and the vast, overwhelming majority of them weren’t on TRT. I’m not advocating TRT; I’m not a doctor. And that’s exactly the point. TRT should be a treatment discussion between a knowledgeable doctor and an informed patient, with all possible risks and benefits disclosed and discussed. Even if there are increased risks for certain men, maybe those risks are pretty low overall … and maybe they’re worth it to the men choosing to fill and refill the prescriptions. Just like all the folks who are willing to risk cancer to get 75 percent clearer skin. As long as patients are being properly informed, and appropriately treated and monitored, what’s the problem?

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, 2017. All rights reserved. For informational purposes only, not to be construed as legal or medical advice.

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