December 9, 2020 | 12:00 PM (MST)
In the last webinar I reviewed several long-term studies demonstrating the benefit of testosterone in reducing body fat, BMI, BP, the metabolic syndrome, diabetes, and dysmetabolism. The increase in lean body mass accompanied with a reduction in visceral fat resulted in a “cure” of diabetes, as opposed to control of DM with medications that simply lower HgBA1C. Controlling diabetes with multiple medications to lower HgBA1C is completely different than curing DM whereby the HgBA1C is normalized without medication. Unfortunately, most diabetic medicines including insulin dispose of blood sugar by cramming it into the cell where it is stored as fat. This increase in cellular fat, and visceral fat, with diabetic medications has not improved CVD outcomes in any long-term study, wherein there is in increase in CVD due to the increase in fat deposition as I discussed last year in the Beyond Hormones course. These studies were published in JAMA and NEJM. It is of profound importance to realize that long-term studies with diabetic drugs to lower HgBA1C and control diabetes DO NOT result in improved CVD outcomes. These studies demonstrated worsening of CVD outcomes despite better control of diabetes with medications. So, then, what else can we do and what else should we do?
Multiple studies have proven that statins increase risk of diabetes which leads to the above scenario. Part of this is due to the 50% reduction in testosterone levels with statin use. Proponents claim that the benefits outweigh the risks. I’m not so sure of this as the absolute risk reduction (ARR) of 1-2% of CVD with statin use is very underwhelming. So, then, what else can we do to improve CVD outcomes and not make them worse with diabetic medicines, or increase the risk of DM with statins? In webinar # 5, we reviewed the success of testosterone in treating and preventing diabetes and improving cardiovascular risk factors and CVD markers. In webinar # 6, I will introduce all the long-term studies demonstrating that testosterone administration is the secret to success in treating CVD as well as reduce CVD morbidity and mortality. And this is in secondary prevention studies where the patients already had established CVD. The overwhelming benefits of testosterone on CVD outcomes is unsurpassed. There is no treatment that offers all the benefits of testosterone in reducing visceral fat, dysmetabolism, dyslipidemia, inflammatory markers, cardiovascular markers, and morbidity and mortality. Multiple outcome studies demonstrate these benefits. Despite the tremendous data and studies that demonstrate the foregoing, testosterone continues to be denigrated, ignored, downplayed, and chastised by the cardiovascular world. Shame on them for ignoring and rejecting science as well as a drug/medication that proves benefit above all other treatments.
Do not ignore the medical literature that proves significant benefit of testosterone in weight loss, improved metabolism via increase in lean muscle mass, a decrease in dyslipidemia and dysmetabolic syndrome, a decrease in BP, a decrease in inflammation, and a decrease in CVD and DM. I provide the studies presented to patients to provide credence as to why we optimize hormones. More importantly, in lieu of the foregoing demonstrating testosterone’s benefit in reducing CVD risk factors, we still must prove benefit in outcome studies. I will review those outcome studies that everyone should have in their library. Sooner or later we will encounter patients or colleagues that we question our use of testosterone or disagree with the use of testosterone. It is always nice to have the medical literature to give them and say, “Here, read this!” We will provide all the copies of the literature reviewed to keep in your library of articles demonstrating the benefits of BHRT.
Neal Rouzier, MD