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Review by Wm Olkowski, PhD, 3.2.11
Here is another radical book by a practicing M.D., this time a Harvard Medical School urologist. The radical idea is to treat low testosterone, a most common occurrence with aging males, with supplemental testosterone. Morgentaler is an expert on use of testosterone to treat “low T” as he calls it. This idea, like many others in today’s more enlightened medical world, swims against the JAMA tide and the zeitgeist that treats low testosterone by lowering it still more. Morgentaler was the usual urologist treating hundreds of men by lowering their testosterone levels once a test showed low testosterone. Sounds weird, doesn’t it?
Apparently, mouse studies first showed that human male, biopsied tissues would grow tumors when stimulated by testosterone injections. Later dogs with benign prostate enlargement (as with humans) were shown to have their prostates shrink when castrated. So the urologists treated men the same way, after a biopsy showed prostate enlargement and tumor like growth. The result was to do the same with men, castrate them and use meds to lower “testo” further, a practice that continues today, unfortunately. Supplementing with estrogens, for example, lowers T. Ironically, the investigator who did this work, Charles B. Huggins, got a Nobel Prize for these discoveries, in 1966. The prevailing wisdom became: to prevent prostate cancer due to low T, lower it further by castration and meds. Now think of all those men who had biopsies and prostate cancer based on this erroneous idea.
Morgentaler’s awakening came about slowly. At first he started to treat men with low T with testosterone. Then he was warned by one of his teachers, who he respected, to stop treating men with low T, as the treatment would lead to prostate cancer. Morgentaler then did what a scientist does: collect more information. So he had his patients who showed low T get a biopsy, itself a gruesome procedure. The very first man he had do this test showed prostate cancer even though all else was normal (i.e., a normal digital rectal exam and normal PSA). This was strange since low T was thought to be protective. He next did the same tests on 33 men with low T, and 6 had cancer, a high rate. His report at a national urology conference resulted in having his work called “garbage”.
With a 50-man sample, he submitted a paper to the official organ of the American Medical Association for their journal, abbreviated JAMA. The editors, who are the gatekeepers on the paradigms of medicine, rejected his paper saying the sample size was too small. Finally at 77 men, 11 of whom had prostate cancer, the paper was published. This 14% cancer rate was several times higher than any other report on men with normal PSA (4.0 ng/mL or less). His conclusion at the time was that low T was not protective for prostate cancer.
Further studies compared two groups of men, all treated with “T therapy”, one (n=20) with then thought-to-be high risk with the “precancerous” condition called intraepithelial neoplasia (PIN), the other (n=55) with normal biopsy results. After one year both groups showed modest increases in PSA, with only one man in the high-risk group (PIN) developing cancer. That’s a rate of 1.3 %, compared to the then-known rate of 5%, after one year in men at high risk. The known 3-year rate of men with high PIN risk was 25%. Overall T therapy did not increase cancer rates, in fact, T therapy showed promise as a treatment. This was heresy. Low T leads to prostate cancer is the most obvious conclusion. He finally wrote a review paper in the New England Journal of Medicine (2004), after a year of literature examination. That paper, which reviewed 15 long-term studies examining blood levels of hormones and cancer, and an additional six or so since, all showed no increase in cancer rates with high T levels.
All this points in the right direction, but something further adds more spice to this shocking story. On one day with some free time, he went in search of the original articles published by Huggins. And what he discovered: “… changed my views on testosterone, prostate cancer, and even more on medicine itself”. The original article (1941) WAS DONE WITH ONLY 3 MEN, BUT ONLY TWO WERE REPORTED, AND ONE WAS ALREADY CASTRATED. SO, THE STUDY WAS BASED ON ONE PERSON. And the results were developed with a blood test that has since been considered erratic. Further examination of the literature showed results that continued the surprises.
One study of men with metastatic cancer treated with testosterone did not show any enhanced growth beyond what would have occurred without treatment. Then another showed no relationship between blood levels and prostate levels with injected T and its metabolite DHT. The biochemical markers of prostate growth did not change with injections of T nor DHT. Finally, the situation was cleared up: at very low T levels, near the castration range, T injections caused prostate growth, but once above the prostate saturation levels, there was no growth. So once saturation occurs (usually at low levels), there is no threat from further testosterone supplementation. Further studies have confirmed these results.
This little book is a life changer for any man with the courage to buy (about $10), read and understand it. Testosterone is important for all the cells of the body, not just the reproductive tissues. And once you realize this fact and can learn to appreciate how changing T levels affect the aging male body, new hope for prevention of prostate cancer (and other maladies) and even its treatment with T therapy, will become common. Maybe even Medicare will pay for supplemental hormones since it should reduce a great many other costs.
But using supplements is not a panacea. The other barrier is the taboo one – discussing sexual performance. Again this book is essential for any aging male (and can also be appreciated by any female). I regularly buy extra copies and give them away to friends, but I fear many do not read nor understand how important this information can be in reducing pain and suffering.
I add this story to the low fat story, the diabetes story and to the statin story. The case is building for a new massive change in health care, but how long will it take?