Dr James Schaller
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Age Related Declines in Hormones

Should You Replace or "Age Normally"

Testosterone and the Heart

"Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an underground dictatorship ... To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic and have no place in a republic ... The Constitution of this republic should make special privilege for medical freedom as well as religious freedom."

Dr. Benjamin Rush, signer of the Declaration of Independence

Michael was 35 years old and for some reason I added a free and total testosterone to his lab tests. It came back very low. Some physicians and government agencies feel it is not "acceptable" to put a 35 year-old man's testosterone back to a level that fits his age. Some also feel that the "new healthy elderly" &nspace; the folks who are 50-70 and who would have been dead a century ago &nspace; should also not get any testosterone replacement as their levels drop.

I will not offer any comments to try to solve this controversy for you. But some doctors feel very strongly that the medical research and clinical experience from the last 70 years, shows that testosterone is not an optional hormone or a vestigial hormone that you can lose. You can decide for yourself what ideology and medical position you support, in consult with the FDA, the DEA and your local physician. Below is a study on the use of low dose testosterone in men with heart failure.

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Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial.

AIMS: Chronic heart failure is associated with maladaptive and prolonged neurohormonal and pro-inflammatory cytokine activation causing a metabolic shift favouring catabolism, vasodilator incapacity, and loss of skeletal muscle bulk and function. In men, androgens are important determinants of anabolic function and physical strength and also possess anti-inflammatory and vasodilatory properties. METHODS AND RESULTS: We conducted a randomized, double-blind, placebo-controlled parallel trial of testosterone replacement therapy (5 mg Androderm((R))) at physiological doses in 76 men (mean+/-SD, age 64+/-9.9) with heart failure (ejection fraction 32.5+/-11%) over a maximum follow-up period of 12 months. The primary endpoint was functional capacity as assessed by the incremental shuttle walk test (ISWT). At baseline, 18 (24%) had serum testosterone below the normal range and bioavailable testosterone correlated with distance walked on the initial ISWT (r=0.3, P=0.01). Exercise capacity significantly improved with testosterone therapy compared with placebo over the full study period (mean change +25+/-15 m) corresponding to a 15+/-11% improvement from baseline (P=0.006 ANOVA). Symptoms improved by at least one functional class on testosterone in 13 (35%) vs. 3 (8%) on placebo (P=0.01). No significant changes were found in handgrip strength, skeletal muscle bulk by cross-sectional computed tomography, or in tumour necrosis factor levels. Testosterone therapy was safe with no excess of adverse events although the patch preparation was not well tolerated by the study patients. CONCLUSION: Testosterone replacement therapy improves functional capacity and symptoms in men with moderately severe heart failure.

Malkin CJ, Pugh PJ, West JN, van Beek EJ, Jones TH, Channer KS

PMID: 16093267 [PubMed - in process]

Bolding done by Dr. Schaller



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