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Is testosterone therapy safe over the long term?

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by Yuan

Today, I’m writing a post for my older, male readers. Based on the available research, we have no idea if testosterone therapy is safe over the long term. The longest study on test therapy only lasted 3 years. In this post, I want to talk about all of the available research on this topic. There have been some interesting new developments on this topic.

Up until 2013, testosterone therapy seemed very promising. People with existing heart conditions may experience complications, but otherwise healthy people got some great results. In April 2013, a meta-analysis discovered signs of foul play in the previous research:

“In trials not funded by the pharmaceutical industry the risk of a cardiovascular-related event on testosterone therapy was greater than in pharmaceutical industry funded trials”.

In November of the same year, results from the biggest and longest study on test therapy was released. The study started with a sample of 8709 male veterans, mean age 60 years, 1223 men got test therapy. It showed an increased risk of MI’s, stroke and death by 5.8% regardless of whether or not they had pre-existing heart conditions after 3 years. Here is an article about the study for easy reading:

These results are contradictory to a study that was released the previous year. The previous study showed that test therapy can actually reduce the chances of heart disease in males without existing heart conditions.

The recent results are inconclusive

The veterans study used a very large sample spanning the longest out of all existing studies, but factors like red blood cell count, estrogen and DHT levels were not tracked. Part of the sample did not have their testosterone levels retested after starting therapy. In other words, the process was not optimized. Perhaps the non-optimized study was more realistic since most testosterone prescriptions does not include closely monitored follow ups for the following years.

This whole thing leaves a lot of unanswered questions for the long term use of testosterone therapy. The average life expectancy of an American male is 77.4 years old, which surprises me considering the average American’s lifestyle (high sugar, low micronutrients, sedentary, obesity, etc). You can expect to live significantly longer if you make better lifestyle choices and it’s perfectly valid to assume that a man could use test therapy for three decades or longer. A study spanning over ten years following a strict protocol would clear things up.

Who is testosterone therapy for right now?

I wouldn’t recommend it for people that prioritize longevity. If you want to see your grandchildren or great grandchildren grow up to succeed and experience the world as it develops for as long as possible, stick with optimizing your diet and exercise. Wait for conclusive results and more optimal protocols.

On the other hand, testosterone therapy is a good fit for people that want high vitality (higher sex drive, more energy/strength/muscle, etc) for as long as possible. Just make sure you track everything on a regular basis. Get lazy on this one and you could stroke out early.

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