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Are the benefits of androgen supplementation in older men overstated? Might the risks be understated?
In a recent JAMA report, Bashin and colleagues randomly assigned 308 men 60 years or older with low or low-normal testosterone levels to receive testosterone (n = 156) or placebo (n = 152) gel packets daily for 3 years. The dose was adjusted to achieve testosterone levels between 500 and 900 ng/dL.
Cardiovascular outcomes were assessed by changes in common carotid artery intima-media thickness or coronary artery calcium scores (as measures of subclinical atherosclerosis progression). Scores did not differ significantly between the testosterone or placebo groups. Changes in intima-media thickness or calcium scores were not associated with change in testosterone levels among individuals assigned to receive testosterone.
Additionally, sexual desire, erectile function, overall sexual function scores, partner intimacy, and health-related quality of life did not differ significantly between groups. Hematocrit (a measure of red blood cells) and prostate-specific antigen levels increased more in testosterone group.
Testosterone therapy is neither as good, nor as bad, as it has been reported to be.