Hormones at issue -- this time for men

An Institute of Medicine report finds little solid evidence that testosterone replacement therapy provides benefits.

By Susan J. Landers, AMNews staff. Dec. 1, 2003.

Washington -- Many physicians are still haunted by the turmoil that erupted over the use of estrogen plus progestin for managing menopause when the Women's Health Initiative found that hormone use increased women's risk of breast cancer.

It was a finding that shook many doctors and patients -- and even the practice of medicine.

One thing is for certain: No one wants to repeat the experience with another hormone and another population. And that's why questions about testosterone therapy persist.

On Nov. 12 an Institute of Medicine panel recommended that smaller trials to determine the benefits of testosterone replacement therapy be conducted before a large-scale, long-term trial is undertaken. It's a recommendation that has left some physicians wishing for more.

"I think it would have been nice if we could have started something equivalent to the Women's Health Initiative very quickly," said John Morley, MD, a professor of geriatrics at Saint Louis University College of Medicine.

In the five to 10 years it takes to conduct such a study, the testosterone replacement industry will likely continue its rapid growth. "By that time we are going to be looking at a $2.9 billion industry and a huge number of prescriptions," said Dr. Morley. Instead, "I think we'll see a lot of little studies, some will be positive and some negative, but what we won't know and desperately need to know is, 'Are there any really bad side effects?' "