Pros, cons of testosterone therapy
Q: My husband, 76, is on testosterone therapy and says he feels great. But I heard there was a new study that was negative about the side effects of the therapy. What’s the real deal?—Gladys F., Plano, Texas
A: The news that you’re wondering about was actually a series of seven coordinated studies published in JAMA that involved 12 academic medical centers. They looked at the impact of testosterone therapy in hundreds of men 65 and older who had measurably low levels of the hormone. (About 20 percent of men over 60 have diagnosable low testosterone.)
The findings: One less-than-positive conclusion was that cognitive impairment was not improved at all for these guys with testosterone therapy. Also, guys taking the supplements saw an increase in noncalcified plaques in the coronary artery, which could be risk for a future heart attack, angina or stroke.
On the plus side: Researchers found that the men gained bone strength and density in their spine and hips. This may reduce the risk of often life-altering fractures—did you know osteoporosis affects about 25 percent of men on Medicare? Hemoglobin levels also went up in men with low testosterone levels and anemia. And sexual function, activity and desire improved over the course of a year.
So the benefits and risks all depend on your husband’s overall health, his goals for taking testosterone, if he was really deficient (low testosterone is considered below 275ng/dL), and how the supplements make him feel.
He and his doctor can make a considered judgement about those matters—he should ONLY take testosterone if prescribed and obtained from a reputable pharmacy!
Also, make sure, since blood clots are a risk when taking testosterone (just like with estrogen and progesterone), that he talks with his doctor about the benefits
of taking a low-dose aspirin in the morning and at night. Our tip: If his physician doesn’t discuss this with him, he might consider getting another doc.
Q: After I herniated a disk, I developed high blood pressure—150/90. Now I have a torn rotator cuff. (I overdid the golf practice after fixing the disk). I eat carefully, cut way back on red meat, but I have to ice my shoulder almost every day to ease the pain. Is it possible that the pain is spiking my BP?—John W., Toledo, Ohio
A: You have identified a too-often overlooked repercussion of acute and chronic pain, which you have from your disc and rotator cuff injuries: high blood pressure. Blood pressure becomes elevated because pain stimulates the sympathetic nervous system, and that affects the hypothalamus and pituitary glands. They pump up stress hormones, elevating your pulse rate. Blood vessels may constrict while the heart rate goes up, increasing pressure even more. Pain also causes emotional stress, and studies show that, too, taxes the heart.
Your best bet? Address the physical issues pronto. Elevated blood pressure usually comes back down when the pain disappears.
If you need rotator cuff surgery to restore function and relieve pain, get it! Your elevated blood pressure, if not accompanied by other cardio problems, shouldn’t interfere with getting cleared for the operation.
Other suggestions: Adopt a stress-response-reducing regimen that includes 15 minutes daily of mindful meditation (you’ll find instructions at sharecare.com); get seven to eight hours of restful sleep nightly (no digital devices or TV in the bedroom; use light-blocking shades); and experiment with reducing your sodium intake to see if that affects your blood pressure (opt for spices and herbs for flavoring).
(c) 2017 Michael Roizen, M.D.
and Mehmet Oz, M.D.