Testosterone is important for regulating sexual function, cardiovascular health, physical performance, cognitive skills and mood regulation in men. According to a review of more than 200 trials, researchers concluded that testosterone supplements don’t work as well as they are marketed for men with low testosterone, also commonly known as ‘low T’.
Adriane Fugh-Berman, MD, a pharmaceutical marketing expert at Georgetown University Medical Center said, “Testosterone has been marketed to improve a number of conditions but for the vast majority our review of the data shows that not one of these claims has adequate clinical trial support.”
Fugh-Berman and her colleagues conducted a review of 226 eligible randomized controlled trials conducted between the years 1950 and 2016. They analyzed the effectiveness of testosterone for cardiovascular health, sexual function, physical function, mood and cognitive function.
Testosterone is an important sex hormone responsible for healthy body functions in males, such as growth and development of masculine characteristics. Low testosterone occurs when testicles fail to produce the hormone in healthy quantities. Low testosterone can be due to a variety of factors most common of which are genetic problems or chemotherapy and injury to the testicles.
Testosterone doses vary on a person’s medical condition, height and weight, age, and current testosterone level. They also vary on a person’s medical history. FDA-approved testosterone formulations include topical gel, transdermal patch, buccal system, which is applied orally to upper gum or inner cheek, and injection.
The researchers excluded studies that involved testosterone functions on bodybuilding, contraceptive effectiveness, or treatment of any condition in women or children.
The researchers concluded that testosterone supplement did not show any evidence that pointed towards a consistent benefit for cardiovascular risk, sexual function, mood and behavior or cognition.
They further added that there is some minor benefit of using the supplements to improve cardiovascular health but nothing substantial that would point towards prominent clinical benefits. According to the ,researchers studies that examined clinical cardiovascular endpoints did not favor testosterone therapy when compared with the placebo effect.
The researchers further went on to add that testosterone was ineffective at treating erectile dysfunction and had no effect on sexual drive or libido. Testosterone did improve muscle strength but did not show any overall improvement on physical function.
As far as regulating mood is concerned, most studies on mood-related endpoints found no beneficial effect of testosterone treatment on personality, psychological well-being, or mood, according to the researchers.
“Testosterone products are marketed for non-specific symptoms associated with normal aging, but testosterone is not a reasonable treatment for aging,” says Fugh-Berman. “Testosterone has known risks and no clear benefits, and shouldn’t be used by men with intact testicles.”
Testosterone treatments have been assigned to patients who are suffering from obesity, diabetes, hypertension or are chronically ill. The reason for this is that patients suffering from these diseases have low concentrations of testosterone in their blood.
However, the direct causality link is still to be figured out as it is unknown whether obesity or lack of exercise and chronic disease lower testosterone rather than low testosterone concentrations cause obesity. It is also possible that other factors are in play that increase the risk of such diseases and also lower testosterone levels.
There could also be a severe shortcoming in the studies since healthy men were sometimes prescribed testosterone which could unfairly give birth to an association of health with testosterone rather than actually improving health.
The researchers also observed some studies that showed testosterone therapy was associated with some pretty extreme healthy risks. Men who were treated with testosterone had an increased risk of all-cause mortality, myocardial infarction and stroke compared to men who did not use testosterone.
Another large cohort study of 56,000 patients concluded that myocardial infarction rates were exponentially increased within three months of testosterone treatment being started; testosterone-treated men over 65 experienced double the rate of myocardial infarctions compared to men who did not receive any testosterone therapy.
Testosterone treatments were similar in women who were prescribed menopausal hormone therapy. Doctors prescribed the treatment to women to lower risk of cardiovascular disease because observational studies showed that women who took menopausal hormones had lower heart disease than women who did not.
Testosterone treatments have also been linked to an increase of prostate cancer risk due to higher than normal levels of testosterone in the blood.
Testosterone treatments have been shown to upset body’s hormonal balance which can lead to enlargement of male breasts, skin irritations, acne, oily skin and changes in hair patterns and hair growth.
Randomized controlled trials, however, showed that this therapy technique increased the risk of heart attacks and stroke. It is likely that healthier women were prescribed this therapy just as healthy men were prescribed testosterone supplements, meaning it was unfairly perceived that testosterone was linked with healthier outcomes.
In 2012, testosterone therapy sales exceeded $2 billion and sales continued to increase in many countries due to the fact that testosterone was misleadingly linked with health improvements in terms of cardiovascular health, physical performance, cognitive skills and mood regulation in men.
The researchers found no proof that testosterone benefits outweighed the risks. Given the known risks of testosterone therapy and the lack of evidence for clinical benefits in normal men, researchers think no further trials of testosterone are necessary.
There are other supplements as well that have their own associated potential risk factors such as zinc and creatinine. In high dosages zinc can cause fever, coughing, stomach pain and fatigue, whereas creatinine can cause adverse reactions in patients with kidney disease or asthma.