One of the fastest growing anti-aging product categories for men is testosterone replacement. Just like women’s levels of key sex hormones decline with age, some men have reduced levels of testosterone as they age. There is some controversy about whether “andropause” is a real phenomenon, but testosterone replacement clearly has benefits for men with a deficiency.  Treating reduced testosterone levels is becoming a big money business.

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Scouting through the literature today revealed a study in the journal Circulation. This study showed that low testosterone was a predictor for cardiovascular disease in aging men.

Searching the archives of this same journal finds that in 1999, this study found, “Short-term intracoronary administration of testosterone, at physiological concentrations, induces coronary artery dilatation and increases coronary blood flow in men with established coronary artery disease.” The study actually infused testosterone at normal levels into the coronary arteries of men and observed the flow rate effects on the arteries. Italian researchers found that normal testosterone levels improved ischemia in men who already had heart disease according to this study.

This is one journal and 3 studies. All of these show positive findings relative to testosterone levels in aging men. Searching the endocrine literature reveals more of these kinds of studies. Looking back to last week, the bias of JAMA is more apparent the farther one looks into specialty specific journals.

The new issue of the Journal of the American Medical Association has published a Dutch study on the use of testosterone in aging men. This is interesting because the study itself comes to some interesting conclusions. The Dutch researchers concluded that oral testosterone replacement in men improves lean body mass but did not result in weight loss as seen in other studies of the hormone. They also used a quality of life measurement scale that resulted in no measurable quality of life improvement. The study also showed no improvement in cognitive function amongst those in the study. The study is followed by a lengthy comment and literature review.

Several problems with the study appear on even the first reading. While the Dutch researchers checked for low testosterone in the men in the study before starting medication they did not monitor the testosterone levels through the study. It is entirely possible that the doses of testosterone were inadequate to see the kinds of results that have been documented for testosterone before. Also, the study used oral testosterone for supplementation. Oral testosterone is not considered by those in the know to be acceptable for testosterone replacement. Even the Endocrine Society notes that there are risks of negative effects on the liver from oral testosterone only in their clinical guidelines. Additionally, the paper in JAMA refers to itself as being a “large study” despite the fact there were only 237 test subjects. I personally don’t consider anything less 1000 large, but clearly JAMA differs with me on this. Really, there are statistical rules for analyzing data from numbers as small as 30 and extrapolating to larger populations but this is a dangerous game which is also why so many studies are done over and over again.

The AMA also has a history with anti-aging medicine that’s not good. The American Academy of Anti-Aging Medicine (A4M) has on several occasions made official responses to JAMA articles on hormone replacement because JAMA coverage is universally negative despite what makes it into the endocrinology journals. The responses include this one from 2002 and this one from early 2007. JAMA and the AMA have demonstrated what appear to me to be a political bias against hormone replacement as demonstrated by their ongoing choice to publish only negative studies of hormone replacement.

Since JAMA is very widely read by physicians and covered heavily in the mainstream media, it’s important to make sure you find a physician that reads more than just JAMA if you intend to age against the machine.