TUESDAY, Nov. 27 (HealthDay News) -- Men aged 40 or over with low levels of testosterone may be at increased risk of fatal heart attacks or death from any cause, a British study suggests.
In fact, "The magnitude of the effect was very similar to that of [high] cholesterol or blood pressure," said lead researcher Dr. Kay-Tee Khaw, professor of clinical gerontology at the University of Cambridge School of Clinical Medicine.
However, more work is needed to see whether testosterone supplements should be recommended for men with naturally low levels of the hormone, she said.
"We need to replicate these findings," Khaw said. "We hope we can entice other investigators to look at testosterone levels and see if these findings are confirmed."
Her team published the findings in the Nov. 27 issue of Circulation.
The study included more than 11,600 men ages 40 to 79 who were free of known cardiovascular disease and cancer at the start of the trial. It was done because "there have been lots of studies suggesting that low testosterone may not be good for health," Khaw said. "So, we wanted to see if this could be demonstrated in a large population. Testosterone is hard to measure, the test can be expensive."
The men were divided into four groups based on their blood testosterone levels.
Those men in the highest quarter of testosterone readings -- with at least 19.6 nanomoles of the hormone per liter of blood -- had a 41 percent lower risk of dying over 10 years than those in the lowest quarter of testosterone readings -- less than 12.5 nanomoles of testosterone per liter of blood.
One major question is whether low testosterone is a risk factor itself or just a marker for other risk factors, said Dr. Victor Montori, associate professor of medicine at the Mayo Clinic in Rochester, Minn. He has done his own studies on testosterone replacement therapy.
"It does not mean that replacing or normalizing levels of testosterone would reverse the outcome," he said. "There are other hormones in the blood that are related to other risk factors, such as diabetes and hypertension."
In any case, a testosterone replacement regimen "would not be a walk in the park," Montori said. "It would be a major intervention."
According to Dr. Jorge Plutzky, director of the Vascular Disease Prevention Program at Brigham and Women's Hospital in Boston, the experience of women taking hormone replacement therapy (HRT) shows that hormonal regimens can have their dangers.
Beginning in the 1990s, millions of older American women took HRT, which replaced two female hormones, estrogen and progestin. Early trials had indicated that the therapy might reduce the risk of cardiovascular diseases such as heart attack and stroke in older women.
Instead, the Women's Health Initiative, a major study released in 2002, found that women taking HRT were at increased incidence of stroke, blood clots and breast cancer, noted Plutzky, who is also a spokesman for the American Cancer Society. HRT prescriptions dropped off precipitously after the study's release.
So, much more research is needed on the link between testosterone levels and mortality before doctors can recommend the regimen to men, Khaw said. Such studies might provide "insights and better understanding of disease mechanisms, such as how and why testosterone might be related to poorer health through, for example, insulin metabolism, lipid metabolism or inflammation," she said.
More information
There's more on testosterone at the U.S. National Library of Medicine.
MONDAY, Nov. 26 (HealthDay News) -- More than a third of prostate cancer patients may receive treatments that are inappropriate because of problems they are already having with urinary, bowel or sexual function, a new study suggests.
These mismatches might occur, because patients don't give enough information to their doctor or because their doctor favors a particular type of treatment, according to the report in the Nov. 26 online edition of Cancer.
"We found an awful lot of patients whose treatment seemed to be contraindicated by urinary, bowel or sexual problems they had before they got treated," said lead researcher Dr. James Talcott, from the Center for Outcomes Research at Massachusetts General Hospital Cancer Center in Boston. "That's pretty good evidence that information wasn't transmitted or didn't factor in with the treatment decision."
Unlike other cancers, there are several treatment options for prostate cancer. The treatment that is best for an individual patient is based on several factors, including stage at which the cancer is diagnosed, age of the patient, and existing problems with urinary, bowel or sexual function that the patient has.
Treatments include external radiation therapy; brachytherapy, in which tiny radioactive particles are implanted into the prostate gland, and the surgical removal of the prostate gland.
Although these treatments are effective, each has a different set of side effects. External radiation can lead to bowel dysfunction, brachytherapy can cause urinary problems, and surgery can damage nerves involved in sexual function.
Treating patients who already have problems in these areas with a procedure that could exacerbate their problem is usually not recommended.
For example, treatment designed to preserve normal functions, such as nerve-sparing, prostate-removal surgery, is not appropriate for patients who have already lost sexual function, Talcott said.
To find the extent of treatment mismatches, Talcott's team collected data on 438 prostate cancer patients. Patients were asked to complete questionnaires that included questions about urinary incontinence and other urinary problems, and bowel and sexual dysfunction.
The researchers found that 89 percent of the patients had some level of urinary, bowel or sexual problem before starting treatment. Among these patients, 34 percent of those with one serious symptom had a mismatched treatment, as did 37 percent who had a less serious symptom. Moreover, 40 percent of those who had several symptoms also received contraindicated therapy.
In addition, among patients with significant dysfunction in all three areas for whom no treatment would be recommended, only 5 percent chose watchful waiting. In this strategy, patients are not treated but are followed closely.
These mismatches appear to occur because doctors and patients don't communicate well. Patients are often reluctant to talk about urinary, bowel and sexual problems, Talcott said. "And, sometimes patients override their doctor's recommendation," he added.
Talcott also thinks that physicians can be wedded to a particular treatment at the exclusion of others. "Surgeons believe in surgery, and radiation oncologists believe in radiation," he said. "That may be part of the problem."
To counterbalance physician bias, patients should get another opinion, Talcott said. "Patients should always get a second consult," he said. "It's a good idea to talk with a surgeon, a radiation oncologist and possible a medical oncologist."
One expert thinks that patients need to make an informed decision about which treatment is best.
"The kind of doctor that you see often predetermines the treatment you receive," said Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society. "Urologists are much more likely to have a surgical solution, and those who see a radiation oncologist are more likely to have radiation."
Patients need to be well-informed about their condition and the possible treatments and their side effects, Brooks said. "Patients need to arm themselves with as much information as possible about what their treatment options are, and what some of the contraindications of particular treatments are," he said.
Men also need to know what all the treatment options are, Brooks said. "Men need to be aware that, in some cases, depending on their overall medical condition and the stage of their cancer, that it is, at times, appropriate not to have any active treatment," he said. "Watchful waiting is a legitimate option in a significant proportion of men."
"In addition, doctors need to work with their patient to choose the best treatment option, Brooks said.
"If one takes the time to have a discussion, educate the patient and not rush them into a decision, then you may be able to allow them to get past their emotional response and make a more educated, logic-based response," Brooks said.
Brooks noted that because there are so many treatment options in prostate cancer, patients may insist on a particular treatment even though it's not the best choice for them.
"Where treatments are contraindicated in other places in medicine, doctors don't provide a treatment for a patient just because that's what they say they want," Brooks said. "You explain that that treatment is simply the wrong treatment for you, and therefore, we are not going to take that approach."
More information
For more on prostate cancer, visit the American Cancer Society 
.