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27.02.2020


The health effects of 11 years of testosterone therapy

This is an outright advertisement for testosterone therapy, we thought after reading the study that Farid Saad, associated with pharmaceutical giant Bayer, published in the International Journal of Obesity. If you can believe this research, men with little testosterone in their system not only get healthier through testosterone therapy, but testosterone therapy even reduces their risk of dying.

Study
Saad and his colleagues studied no fewer than 823 men, all of whom had low testosterone levels [of 12 nanomoles per liter or lower] for 11 years. The average age of the men was 60 years.

Of the men, 428 received an injection of 1000 milligrams of the long-acting testosterone undecanoate every 12 weeks. The preparation that the researchers used was Nebido from Bayer.


The health effects of 11 years of testosterone therapy


The remaining 395 men received no testosterone, and also no placebo. Some of these men did not want to use testosterone, for example because they had decided in consultation with their doctor that testosterone was too risky for them. The researchers do not mention how large this group was.

Results
The men in the control group became fatter in the 11 years that the study lasted, while the men in the testosterone group became leaner.

The figures below relate to the men with normal body weight. If you click on them, you will also see the figures for overweight men and men with obesity.


The health effects of 11 years of testosterone therapy


During the trial, blood pressure - both diastole and sytole - rose in the men in the control group. You can see this below. In the men in the testosterone group, blood pressure decreased.


The health effects of 11 years of testosterone therapy


Insulin sensitivity deteriorated in the men in the control group, but improved in the men in the testosterone group.

The effect of testosterone therapy on cholesterol levels was less clear-cut. The LDL and HDL levels deteriorated in the men who received testosterone. For the triglycerides it was the other way around: the level of the men in the testosterone group improved, but the level of men in the control group deteriorated.

Click on the figure below for a larger version.


The health effects of 11 years of testosterone therapy


The mortality in the men in the testosterone group was significantly lower than the mortality in the control group. 19.5 percent of the men in the control group died, and 5.4 percent among the men in the testosterone group.

Conclusion
"Our findings demonstrate that in subpopulations of men in different weight categories at baseline, long-term testosteron therapy produced significant weight loss while untreated men in each subgroup (controls) had increased weight, waist circumference, and BMI", write the researchers. "We wish to point out that, in this study, the majority of hypogonadal men were obese."

"There were 77 deaths in the untreated groups and 23 deaths in the testosterone-groups. No patient dropped out. Medication adherence to testosterone was 100 per cent as all injections were administered in the doctor's office and documented."

"We therefore suggest that adequate long-term testosterone therapy in hypogonadal overweight and obese men produces progressive and sustained, clinically meaningful weight loss and this therapy may reduce mortality and incidence of major adverse cardiovascular events."

Hmmm...
Let's see. We have a study here in which more than four hundred hundred men receive injections for 11 years, without anyone missing an injection - and without one stopping treatment. That's striking.

It is also striking that the mortality in the testosterone group is lower than in the control group, even though the cholesterol balance in the testosterone group deteriorates more than in the control group.

Could this be because the control group is less healthy than the testosterone group? for some reason

Maybe testosterone therapy is indeed not as risky as we have always thought. Or perhaps this study does not paint a complete picture of reality. For some reason.

Bayer
The lead author of the research is a full-time employee of Bayer. The second author was paid by Bayer for his contribution to the study. The third author has been paid by Bayer for lectures. Bayer also reimbursed his travel expenses. And the fourth author of this study received money from Bayer for entering the data. He gave lectures at the expense of Bayer and received a reimbursement for travel expenses from Bayer.

Bayer is the producer of Nebido.

Source:
Int J Obes (Lond). 2020 Jan 28. doi: 10.1038/s41366-019-0517-7. [Epub ahead of print].

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