The Endocrine Society, the world’s oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology, is recommending against prescribing testosterone replacement therapy to men 65 years of age and older because the risks and benefits are unclear.
The recommendation is part of new guidelines called “Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline,” which was published in The Journal of Clinical Endocrinology & Metabolism. The recommendation is an update to the Society’s 2010 guideline. The recommendation is based on new scientific evidence from large randomized clinical trials.
Testosterone treatments are intended for men with hypogonadism, a condition in which men do not produce enough of testosterone due to defect, disease or injury. It is not intended for men with natural age-related hypogonadism. In recent years, manufacturers of testosterone replacement therapies have aggressively marketed their products to older men, promising a treatment for symptoms of so-called Low T, which reportedly include low libido, weight gain, and mood swings. The marketing campaign resulted in skyrocketing sales of testosterone therapies.
Studies have suggested that testosterone supplements can increase the risk of heart attacks, strokes and blood clots, some of which can be fatal.
“Some men receiving testosterone therapy do not have adequately documented hypogonadism, while others who have hypogonadism are not receiving the needed treatment,” said Shalender Bhasin, MD, with Brigham and Women’s Hospital in Massachusetts, and chairman of the task force that authored the study.
The guidelines recommend that men only be prescribed testosterone treatments if they are experiencing symptoms of testosterone deficiency, and if their free testosterone levels are “unequivocally and consistently low,” because a person’s testosterone levels can fluctuate greatly over time. About 30 percent of men whose testosterone levels measure low will display normal concentrations when retested, they said.