Testosterone in Older Men

iStock_000002132182_MediumIn our seemingly endless quest for eternal youth, testosterone supplements have occupied a place for older men, but do they really have any impact?  That's the subject of a study in NEJM Rick and I talk about on PodMed this week, and the results don't make a compelling case to use the stuff, in this case, testosterone gel.  What did they do in the study?

A total of 790 men with a serum testosterone measurement of less than 275 ng/dl were randomly assigned to either daily testosterone gel or a placebo gel for one year, with the objective of keeping testosterone levels in the midrange of normal for men 19 to 40 years old in those who received the testosterone. All of the men were 65 years of age or older, and none had health conditions that would contraindicate use of testosterone.  It's worth noting, as we do in the podcast, that finding that number of men among those screened was like the proverbial needle in a haystack: over 51,000 men were screened to yield this relatively small number with established low testosterone levels. Among the men who were on the testosterone gel in this study, they did report improved sexual activity, including improved desire and erectile function. Effect sizes were low to moderate, as they were for some measures of physical function and mood.  There were no adverse cardiovascular events but we wonder if the trial continued longer if some might emerge.  In sum, seems like men who have established low testosterone levels might choose to use the gel if their sexual function was very important to them.

Other topics this week, all from NEJM, include Ebola virus management in the US and Europe, use of pioglitazone in folks who've had a stroke, and a look at carotid endarterectomy or stent placement in people with carotid stenosis but without symptoms.  Until next week, y'all live well.

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