The Good, the Bad, and the Ugly about Testosterone

Good Morning!

Today I am starting the 3rd part of 3 part series on the Good, the Bad, and the Ugly about Testosterone.  Unfortunately, the ugly will have 3 parts. 1.  What happened?  2.  Response to what happened? And 3. Where are we Now? Prelude: In NYC, while working in the ER, I worked a second job as a reviewer of MD in hospital practices.  My reviews were sent to insurance companies who then decided if they would reimburse the hospital or not.   Moving to California, I worked in, and sat on the Committee of Internal Review of Pomerado Hospital, where I saw another side of review.  Here it was the insurance companies denying payment to the hospital for reasons the insurance company should not deny according to their own rules.   It was the first time my eyes were opened to corruption and politics in medicine.  Often, no matter how many times we appealed using the insurance company’s own rules, the hospital was denied payment over and over again.   I stepped aside from the Committee out of frustration as it didn’t seem to matter how the hospital defended themselves; the insurance company could dictate whatever they decided.  Fast forward to present time and having my eyes opened to another gray area and controversy in medical politics.

The Ugly about Testosterone – Part I, What Happened?

Testosterone was discovered in 1935 and approved as a medication in 1939.  It was used in pellet form in post-hysterectomy women to alleviate menopausal symptoms.   After 50 years of use in the US and over 60 years of use in other countries, testosterone, and other anabolic steroids, were declared controlled substances by US Congress in 1990.  This was the same year “documents were discovered showing many East German female athletes, especially swimmers, had been administered anabolic steroids”.

Many feel the US response to this “doping” in the Olympics and Tour De France led to the DEA in 1991 declaring “testosterone a controlled substance which puts it in the same class as heroin and cocaine, and claimed it may be addictive.  Steroid users can experience withdrawal symptoms such as depression and anxiety as their levels drop, but there was never any evidence of addiction”.  (Oct 27, 1999)

The DEA goes on to declare, “Testosterone and other AAS are abused by adults and adolescents, including athletes and body builders. Abuse of testosterone, usually at doses higher than those typically prescribed and usually in conjunction with other AAS, is associated with serious safety risks affecting the heart, brain, liver, mental health, and endocrine system.  Reported serious adverse outcomes include heart attack, heart failure, stroke, depression, hostility, aggression, liver toxicity, and male infertility. Individuals abusing high doses of testosterone have also reported withdrawal symptoms, such as depression, fatigue, irritability, loss of appetite, decreased libido, and insomnia.”

The dangers of testosterone use were seemingly supported by a 2014 JAMA article in which the headlines stated Testosterone given to men at a VA hospital had a higher incidence of stroke, heart attack, and death. JAMA. 2014;311(9):962-963. doi:10.1001/jama.2014.398    “

Because of this article the FDA put a “black box warning” on Testosterone warning practitioners of its possible dangers.

The sad part, and to me ugly part, of all of this is none of the health allegations nor the title about the study at the VA are true.  Many men were taken off their testosterone in response to an article that was not based on the truth and many had poor health related outcomes.

The response to the JAMA article was heard around the world.  This will be presented next week.

Enjoy your awesome day.

Dr D