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“Replacing” a hormone the body normally makes when it is running low isn’t necessarily the safest thing to do. Women and their doctors learned this with estrogen after menopause. Now the FDA is sounding a warning that testosterone therapy can cause potentially dangerous blood clots in men.
Blood clots that form in veins (what doctors call venous thromboembolism) come in two “flavors.” Deep-vein thrombosis, or DVT, is a blood clot that forms in a deep vein, often in the leg. It can make the affected leg swell or cause leg pain. If a DVT, or part of one, breaks away and gets into the bloodstream, it can block blood flow to the lungs. This is called a pulmonary embolism. A large pulmonary embolism can be deadly. Pulmonary embolism, along with DVT, kill as many as 180,000 Americans each year, more than the number of people who die from breast, prostate, colon, and skin cancers combined.
The FDA had previously warned about a testosterone-therapy-related increase in blood clots in men with a condition called polycythemia. Polycythemia is a condition in which the body makes too many red blood cells, which increases the risk of blood clots. Its latest warning comes from reports of blood clots in men without polycythemia.
The new warning is not related to the FDA’s evaluation of possible links between testosterone therapy and stroke, heart attack, and death.
“Low T” is big business. You may have seen ads on television or in other media. Worldwide sales are expected to reach $5 billion by 2017. Testosterone is available as an injection, a gel, an underarm spray, and a nasal spray.
Advertisements for the male hormone imply it may be just what a man needs to boost his energy, mood, and sex drive. Then again, it may not.
Testosterone is made in the testicles. After age 30, most men’s testosterone levels begin to gradually fall. For some men, the decline is faster and steeper.
Experts are trying to come to grips with which men really need treatment with testosterone. Men whose bodies no longer make any testosterone, and those with extremely low levels of testosterone and classic symptoms of low testosterone definitely need treatment. Classic symptoms include:
- low sex drive
- low sperm count
- loss of body hair
- hot flashes
Few men fall into that category. Some men have symptoms that may or may not be related to low testosterone, like
- difficulty concentrating
- little interest in sex
- feeling down
- trouble sleeping
- lower energy level
- less “get up and go”
- decreased muscle mass
Some men with at least one of these symptoms have low testosterone levels. But many others with one or more of these symptoms have normal levels.
Even if the testosterone level is low, it’s possible that these symptoms might be due to depression, low thyroid function, or some other medical problem. And there’s an evidence issue—we don’t really know who benefits from testosterone therapy.
Making the choice
Experts recommend testosterone therapy for men with a low testosterone level and one or more of the “classic” symptoms. For the rest? They get a talk-with-your-doctor recommendation.
The FDA’s warnings highlight that taking testosterone isn’t risk free. Combined with the lack of evidence about who really benefits, it means that the decision to start testosterone therapy is an individual one. A man must weigh the potential benefits against the potential increased risks of heart attack, stroke, and blood clots. If the balance tips in favor of moving forward, then trying testosterone is reasonable thing to do.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
Rejoice always, pray continually, give thanks in all circumstances; for this is God’s will for you in Christ Jesus. 1 Thessalonians 5:16-18 NIV
The Lord your God is with you, the Mighty Warrior who saves. He will take great delight in you; in his love he will no longer rebuke you, but will rejoice over you with singing. Zephaniah 3:17
Rejoice in the Lord always. I will say it again: Rejoice! Philippians 4:4 NIV
Be joyful in hope, patient in affliction, faithful in prayer. Romans 12:12 NIV
When anxiety was great within me, your consolation brought me joy. Psalm 94:19 NIV
The Lord has done it this very day; let us rejoice today and be glad. Psalm 118:24 NIV
Though the fig tree does not bud and there are no grapes on the vines, though the olive crop fails and the fields produce no food, though there are no sheep in the pen and no cattle in the stalls, yet I will rejoice in the Lord, I will be joyful in God my Savior. Habakkuk 3:17-18 NIV
You make known to me the path of life; you will fill me with joy in your presence, with eternal pleasures at your right hand. Psalm 16:11 NIV
Though you have not seen him, you love him; and even though you do not see him now, you believe in him and are filled with an inexpressible and glorious joy, for you are receiving the end result of your faith, the salvation of your souls. 1 Peter 1:8-9 NIV
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