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TESTOSTERONE DEFICIENCY SYNDROMES: THE INVENTION OF A DISEASE?
Prof.Alvaro Morales
Centre for Advanced Urological Research, Queen's University,
62 Barrie St., Kingston, Ontario, Canada K7L 3J7. moralesa@post.queensu.ca
Deficiencies in the production of testosterone (T) by men have been
recognized for over 6 decades. The availability of specific,
effective treatment dates back more than 50 years. However,
since the turn of this century there has been increasing criticism
of the use of T in aging men. The critics variously accuse
the pharmaceutical industry and/or the physicians for preying
on an unsuspecting public anxious to reverse the unavoidable
process of aging. These criticisms are unfounded and unfair.
Although it is true that there is a paucity of long term,
sufficiently powered studies providing evidence beyond doubt
on the safety of T administration there is a plethora of information
on its efficacy. The quality of the studies is variable but
the improvement in subjective and objective parameters such
as the quality of life (including sexual life), bone mineral
density and reversal of sarcopenia are undeniable. The issue
of the safety of T administration remains involved in a shroud
of ignorance, unfounded fears and incomplete data. At this
point, we know that T therapy administered by a knowledgeable
and competent physician to a patient who needs it and realizes
the importance of adequate monitoring carries very limited
risks. When adverse effects from T therapy occur, competent
monitoring allows for their early detection. Adjustments in
dosage, switching to alternate delivery forms or even the
discontinuation of treatment, prevent the development of serious,
life threatening situations. Large, richly powered studies
are in the planning stage. Optimistically we can expect results
in 10 years, at the earliest. In the meantime a clinically
sound approach to TDS based on current knowledge is efficacious
and largely safe.
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