Lecture on Testosterone: A Ubiquitous and Undervalued Molecule

Introduction

• Testosterone is often undervalued and underappreciated.
• Dr. Andy Gay and others have been influential.
• Testosterone is important for male sexual desire, muscle mass, mood, and motivation.
• Historically associated with bodybuilders and anabolic steroid controversy.
• Testosterone deficiency linked to major health issues: type 2 diabetes, obesity, osteoporosis, coronary artery disease.

The Importance of Testosterone Therapy

• Many men suffer from testosterone deficiency which is often undiagnosed or untreated in primary care.
• Fear of prescribing testosterone due to FDA label changes in 2015.
• Benefits shown in conditions like COVID-19, reducing severe infection rates and mortality.

T Trials (2016)

• Largest randomized trial to date with 790 men over 65.
• Showed improvement in physical mobility, mood, energy, bone density, and strength.
• Benefits often dismissed as minor.

Benefits of Testosterone Therapy

• Improves symptoms of testosterone deficiency.
• Enhances sexual function, mood, reduces anemia, improves bone density and strength.
• May reduce fracture risk, vascular, and overall mortality.
• Low testosterone levels associated with increased risk of dementia and Alzheimer’s disease.

Evidence of Testosterone Benefits

• Improves sexual function modestly.
• May alleviate mild to moderate depression.
• Enhances bone mineral density, muscle mass, reduces fat mass.
• Potentially reduces cardiovascular and all-cause mortality.

Upcoming Research: Traverse Study

• Five-year study on testosterone gel vs. placebo in 3,000 men.
• Investigating testosterone therapy’s effect on type 2 diabetes.

Australian Study on Testosterone and Type 2 Diabetes

• Randomized trial with men aged 50-74 with low testosterone levels.
• Showed testosterone plus lifestyle reduced type 2 diabetes prevalence by 41% compared to placebo.

Testosterone and Prostate Cancer

• Testosterone therapy linked to lower risk of aggressive prostate cancer.
• Hypogonadal men may have more aggressive prostate cancer.
• Study showed lower recurrence rates of cancer in men receiving testosterone therapy post-surgery.

Cardiovascular Effects

• Largest analysis of testosterone trials showed no significant increased risk of cardiovascular events.
• Lower testosterone levels linked to higher dementia and Alzheimer’s risk.
• Hypogonadism linked to higher hospitalization rates for COVID-19.

Men's Health and Testosterone

• Affects all major chronic diseases and transcends racial, ethnic, and socioeconomic boundaries.

Erectile Dysfunction and Upcoming Research

• New guidelines and research on erectile dysfunction and lifestyle impacts.
• Potential poly pill combining statins and tadalafil.
• Recent study indicating cardiovascular risk reduction with PDE5 inhibitors.

Conclusion

• Testosterone plays a crucial role in health and disease prevention.
• More research and awareness needed to address misconceptions and promote its therapeutic benefits.