Why Are Doctors Ignoring Testosterone Replacement Therapy?

There have been quite a number of studies recently showing that, not only is testosterone replacement therapy (TRT) very safe, but it also brings with it many additional benefits beyond boosting libido and reducing erectile dysfunction. These add-on benefits, as it were, are only now beginning to emerge from the medical literature and they are very interesting. They would include:
• A reduction of Type 2 Diabetes. Reduced insulin requirement.
• Reduction of serum lipids and a decrease in the incidence coronary artery disease.
• A reduction of mortality arising from the Metabolic Syndrome.
No matter how you do your sums, these are fairly spectacular benefits to accrue from one simple and now known to be a safe line of therapy. And yet very surprisingly the majority of doctors continue to ignore TRT for older men. In doing so I would contend that they are denying their older male patients a better quality of life and a lower risk of early death. That is a very serious charge indeed.
So why is this I wonder? As a doctor I make no apologies for the behaviour of my colleagues. In fact, to be perfectly honest with you, I believe that doctors ignoring TRT is an indictment against the profession. This may well prove to be so in time. Nonetheless, I would offer the following observations to explain why doctors are not using TRT. Each is erroneous of course and I will explain why as we go along:

  1. The results of the Women’s Health Initiative study into the safety of HRT for postmenopausal women were published in 2002. This sent shock waves through the medical profession. It showed an increased risk of breast cancer and heart disease among those women on combined hormonal replacement therapy as distinct from those not on any such treatment. The increase for cancer was of the order of eight extra cases per 10,000 women on HRT.
    Fallacy: You simply can not extrapolate anything from this important study and apply it to testosterone replacement therapy for men. To do so would be utterly illogical. And yet I believe that at some subliminal level that is what’s happening. All hormonal replacement therapy is now being tarred with the same brush, if only at some illogical subconscious level.
  2. Another misconception warmly embraced by many doctors is that ageing is natural and the negative consequences of ageing, such as the loss of libido and erectile dysfunction, are best not interfered with. There are prejudices at work here of course. These very same doctors would never shrink from aggressively treating hypertension or osteoarthritis in men, no matter what age they are. But ask them to consider the older man’s sexual life and all sorts of objections will be thrown up.
    Fallacy: There are far more benefits for the older man on TRT than mere libido boosting or improved sexual function. Recent studies have clearly indicated that this safe treatment carries many additional advantages. Not least of these is a reduction in early mortality arising from the Metabolic Syndrome.
    If you are planning on visiting your doctor with a view to asking to be placed on testosterone replacement therapy then you had better be forearmed. You may very well meet some unexpected resistance. Do your homework carefully. Bring with you a resent paper showing that the incidence of prostate cancer is not changed in any way by taking TRT — this research has only recently been published.
    At the end of the day of course you may be just wasting your time. In general, doctors do not like been told what to do by their patients. Doctors like to think that they are in charge. In any case, if you have to persuade and browbeat a doctor into doing something the chances are that, if given at all, it will be given in bad faith and is unlikely to benefit you in the way it should do. My final advise therefore is to shop around.