Zorba Paster: The Jury Is Still Out On Testosterone

Dear Justin: When a guy is in his 20s, his testosterone level is high, but as we age it drops off. So is this a good thing? Should we replace it?

We doctors got into trouble when we used to tell nearly every woman she should have estrogen in menopause. We thought it would make her a more natural woman and keep her from having a heart attack.

We were wrong — dead wrong. Heart and Estrogen/Progestin Replacement Studies (HERS1 and HERS2) showed that this approach actually produced more heart attacks and strokes. The result: Prescriptions for female hormones dropped off the map.

But when it comes to testosterone, it’s a new field. Why? There is lots of money to be made.

A prescription of testosterone gel costs about $550 per month, with many insurance companies not paying for it. You have to have a significantly low testosterone level before they will step in.

A recent series of articles published in the New England Journal of Medicine looked at men with “Low T.” Nearly 800 men 65 and older got either testosterone gel daily or a placebo for one year.

The men who got testosterone moved it to a level you would see in 20- to 40-year-olds, turning back the proverbial clock. There were tests for strength, endurance, vitality and, of course, sex.

This was not one study but several studies, well-designed, that tried to answer the questions: Does it work? And is it safe?

The results were dismal. The “High T” men did only minimally better on walking tests and endurance. They did not have improved mood, less depression or more vitality. They did have a bit more sex, but that tended to diminish over time.

Let’s step aside for a moment and look at the cost, the bottom line for most testosterone takers. Assuming you have sex twice a week, it costs about $50 per orgasm for a person on testosterone, and over time it doesn’t seem to work as well. The cost per orgasm of Viagra and Cialis was about $10 less, at $40.

Now, if you go through a Canadian pharmacy (which, by the way, is illegal) then the cost per 100-milligram tablet is $10 for a brand-name Viagra from Pfizer and $1.67 for a generic version manufactured by another company, which is not Canadian. Clearly, our Canadian buddies pay less per orgasm than we do!

If we look at the safety issues regarding testosterone, those have not been answered. The theory is that this might increase cardiovascular disease. But the study did not go on long enough to answer that question.

Before you decide if “T” is for you, let’s look at who participated in the study. Although it was a well-designed study, the criteria for entry were so stringent that only 1.5 percent of those who wanted to be in the study qualified.

Of those, the average age was 72, with 90 percent of them white, most of them overweight, and many with high blood pressure. A third of them had diabetes and 1 out of 5 had sleep apnea.

The study did not answer the question of whether testosterone is good for healthy older men. They weren’t in the study.

My spin: If you’re thinking of testosterone replacement for orgasm, it’s not worth the price. It’s cheaper for you to get on a plane to Montreal and bring home a bag of Viagra.

If you want to feel fit, you should lose weight, exercise more and eat a healthier Mediterranean diet. But if your testosterone level is super-low, you might want to try a three- to six-month trial with the stuff. It would take that long for you to know if it works.

These studies have not solved the quandary. Stay well.