Meta-analyses of placebo-controlled trials suggest that testosterone therapy in physiological doses is significantly associated with increased haematocrit, reduced high-density lipoprotein cholesterol and prostatic symptoms. 29 , 30 If prostate cancer has been excluded, there appears to be no increased risk of induction by testosterone therapy. There is inconsistent evidence regarding the risk of cardiovascular events. 29-31 A recent meta-analysis suggested increased cardiovascular risk and reported publication biases. 32 Long-term safety data are lacking, but recent reports more strongly suggest an increased risk of cardiovascular events in older men. 3 , 4 This has prompted the Endocrine Society to issue a warning statement. 5 The results and safety of long-term prospective controlled trials of testosterone therapy are awaited.
“There are a lot of other things we can account for hormonal changes,” says Alukal. “The things people have shown repeatedly, and in very large studies, that you can bank on are inadequate sleep, increased work-place stress, decreased exercise, eating like crap, and too much exercise.” And keeping your hormones in check is a matter of common sense, he adds. The signs of an imbalance include feeling unusually exhausted, an upsurge of mood swings, noticing a new intolerance for exercise, the inability to maintain your normal body weight, and a decreased interest in sex. While these feelings could have other clinical explanations, Alukal says he first makes sure there isn’t a much simpler explanation for his patient’s conditions: a hormonal imbalance.