Should you consider using testosterone? Do the benefits outweigh the risks? Read on

I bet few of you remember the Lawrence Welk Show. Will Geritol, heavily hawked by Mr. Welk, help jog your memory? Of course! This was the iron supplement advertised as “twice the iron in a pound of calf’s liver.” It also contained some B vitamins, and best of all: 12% alcohol. The claim was that if you feel tired, listless, deflated, you need more iron to make you feel energetic, happy, and as the images of happy wives implied, a revivified sexual performance. The claims were banned by the FTC as false advertisement, although a bit of iron excess hasn’t killed anybody (a large excess may cause hemochromatosis, a serious “side effect”).


Enter testosterone

Ah, for the good old days. Today, we don’t even bother with such small potatoes as vitamins and minerals. We graduated to hormone “therapy”: If you feel tired, listless, deflated, sexually inadequate, have we got a pill for you. As one ad reassures: “Low T? It’s only a number. Dial it up (Haha, which ‘it’ do they mean?)!” And another promises “power, performance, passion”.


Follow the money

Why this onslaught of advertisement? In the U.S. alone, manufacturers of testosterone spent $152 million in 2013. This is an increase of 2,800% since 2009. Did this dizzying increase work for them? You be the judge: The number of prescriptions rose from 2.9 million in 2007 to 7.5 million in 2013. Sales in 2013 were $2.4 billion, and projected to reach $3.8 billion in 2018 at about $25 of sales per $1 of expenses, not a bad rate of return.

If you watched the video, you’d think that all you would need to do is smear on the gel and voilà. You’ll burst with animal libido, walk on the beach with a gorgeous woman, have a great dinner at a French restaurant, and finish with a crescendo sex to rival Beethoven’s Ode to Joy. And while you watch it, would you be able to also follow the rapid fire mumbling that says the side effects include, but not limited to, blood clots that may end up in pulmonary embolism and death, strokes that may impair your sexual performance (to say the least), hair loss, acne, testicular atrophy, and gynecomastia?

Of course, watching those seductive scenes, how could you? But what if instead of hiding behind medical terminology, he announced in plain English that your balls will shrink, or you’d develop a woman’s breasts (gyne=female, mast=breast)? I’d bet a lot of aging jocks would have second thoughts.

There is one little side effect that is more serious than all the preceding ones. Several studies have shown that on post-mortem examination of men dying of causes other than prostate cancer, about 90% have microscopic evidence of dormant prostate cancer cells; no big deal if you just leave them alone. Other studies have shown that testosterone does not cause cancer, but it can fuel the growth of existing prostate cancer’s cells. Wouldn’t you think that adding testosterone to your naturally circulating testosterone may fuel the embers into a conflagration? This is not just an “academic” concern.

One treatment modality of prostate cancer is “chemical castration”, namely inhibiting the formation, or receptor binding of testosterone. Of course, until clinical trials show a rise in the rate of prostate cancer in men taking the hormone, we’ll never know for sure. But why gamble if the potential costs in health far outweigh the benefits?


Birth of a fad

It is common knowledge among body builders that testosterone would increase their muscle mass. Never mind that they look a bit like gorillas, their own self-image is what counts. But the body-building subculture was looked upon as a strange curiosity, not the stuff that would make an attractive advertising image to promote testosterone use.

In 2008, I noticed a barrage of testosterone ads on CNBC, the financial station. Why this advertising campaign? The answer came to me from an unexpected source: The Proceeding of the National Academy of Sciences published in April of 2008.

J.M. Coates, the lead author, is a neuroscientist at Cambridge and previously a trader on Wall Street, took saliva samples from 17 male traders on a London stock trading floor twice daily over the course of eight days. He and his colleague J. Herbert, monitored the traders’ levels of testosterone, the hormone most often associated with aggression and sexual behavior, and cortisol, the so-called stress hormone. What they found is that high testosterone not only predicts, but actually causes a winning streak. This finding is corroborated by a finding of studies of athletes, and of baboons in Kenya.

In short, high testosterone generates a winning streak through a positive reinforcement loop. High testosterone begets higher rates of success, which in turn causes a further elevation of testosterone levels. But this is not cost-free. As testosterone levels increase euphoria, judgement suffers. That in turn brings success to a screeching halt. Stress increases. High level of cortisol, the stress hormone, creates an opposite loop of anxiety and underperformance.

As an aside, this neurobiological observation laid the behavioral basis for financial boom and bust cycles. Six months after its publication, the world financial system was dealt a body blow, the social consequences of which are still with us.

Back to the advertisement campaign. This is purely my conjecture, but the coincidence of the publication of the PNAS and the unleashing of ads on CNBC, shortly thereafter, suggests that finally the testosterone peddlers found a great image: financial jocks are much more respectable then the physical ones. The success was immediate, and big. Sales shot up, more and more TV channels started broadcasting the message: testosterone will make you more of a man—financially successful, physically athletic, sexually active. And the downside? Just barely decipherable in the rapid-fire mumble (where is the FTC when we need it)?


How will it all end?

My guess is it will end in tears, and lawsuits. Very similar to the Hormone Replacement Therapy for women promoted to avert the symptoms of menopause and aging. When studies showing increased rates of morbidity and mortality from strokes, heart attacks and prostate cancer will be published, common sense will prevail, as it always does, eventually. Until then, stay away from the stuff.

Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.



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