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Too much testosterone

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UTMB study shows hormone over-prescribed despite known possible link to prostate cancer

By Travis Gumphrey

A STUDY by the University of Texas Medical Branch in Galveston has found that testosterone is often prescribed to patients when not medically necessary.
Recently, there has been a dramatic increase in testosterone prescriptions as aging men look for a way to keep their muscles toned and their romantic urge in good shape.
But there are questions about the practice as the long-term effects of testosterone treatment are not yet fully understood by doctors and scientists.
The nationwide study of about 61,000 men aged at least 40 found that 20 per cent had been prescribed the steroid hormone even though they had normal levels of testosterone.
The study also found that 39 per cent of new testosterone users had not had a prostate-cancer screening during the year before treatment and that 56 per cent had not been screened during the year after starting treatment.
The Endocrine Society, an organization dedicated to the research of hormones, recommends that testosterone therapy should only be prescribed to men with low testosterone levels and no signs of prostate cancer.
The UTMB analyses also found that 25 per cent of men included in the study had not had their testosterone levels checked before receiving a prescription. Of those, nearly half had not had their levels checked during their first year of treatment.
In announcing the study’s results, Jacques Baillargeon, UTMB epidemiology professor and lead author of the study, said: “These findings show that there may not be a consensus among physicians regarding the definition of low testosterone.
“It’s possible that, in some cases, physicians judge that a patient’s symptoms, such as fatigue and loss of muscle mass, merit testosterone therapy without clinically defined low-testosterone levels.”
Baillargeon said the low rates of prostate-cancer screening were surprising because, according to Endocrine Society guidelines, screening is recommended for all men before starting testosterone therapy.
Prostate screening is an important aspect to the discussion, considering that there is debate among doctors about the association of testosterone replacement therapy and the initiation, progression and aggressiveness of prostate cancer.
Although there is no clear evidence to link the two conclusively, current recommendations are to exclude prostate cancer before starting testosterone treatment in men older than 40.
“These findings are very important from a medical and public health standpoint given the rapidly increasing number of men receiving testosterone in the USA,” Baillargeon said.
“Further research on the medical decision-making processes involved in monitoring and prostate-cancer screening will be important, given our limited knowledge of the risks of this therapy.”

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