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The Risks and Benefits of Testosterone Therapy
Low testosterone levels, common among men with COPD, seem to play a crucial role in how COPD erodes a man's everyday quality of life; after all, skeletal muscle strength, sexual function and mood have all been linked to testosterone. The hormone has not been proven to reduce the actual respiratory difficulties of COPD, but more and more studies are exploring how testosterone can offset the quality of life erosion that comes with COPD. The findings are very exciting indeed, but the controversy surrounding Hormone Replacement Therapy and testosterone's questioned side effects may stop--or at least slow--a quick embrace of testosterone treatment.
On the one hand, the results are impressive. In a recent 26 week study, 29 men with moderate to severe COPD received an injection of either 250 mg of testosterone or the placebo. By week 12, the treatment group was already showing a "significant" increase in fat-free mass and an equally significant decrease in fat mass. Furthermore, by the end of the study, the men in the treatment group also reported a clear improvement in erectile function and their general sexual quality of life. Other studies, while not all using COPD patients, have found the same sort of reinvigoration, from the mind to the body, for men with low testosterone levels.
Testosterone is very much an engine that powers life; beyond its own effects, which appear to veritably transform all men with or without COPD, the hormone may prove especially beneficial because of the other treatments it may allow. For example, there are studies exploring how a regular testosterone injection, when combined with strength training (resistance, free weights, etc), improves a man's fitness in the face of COPD.
Additionally, other studies have shown that generalized anxiety disorder and panic disorder occur at a higher rate in patients with COPD as compared with the general public. Testosterone's noted mood improvement--whether by the confidence that comes with improved strength or testosterone's sheer chemistry--may very well counteract the anxiety of living with COPD.
Nevertheless, for all its possible benefits, testosterone--and Hormone Replacement Therapy in general--remains controversial. Consider the estrogen fallout, which caused a great national stir much like the Vioxx pullout. In July 2001, the National Institute of Health released findings showing how the popular estrogen-progestin combination actually increased the risk of breast cancer, heart attacks, strokes and blood clots. Like testosterone supplementation, the combination was intended for the upkeep of a postmenopausal women's quality of life.
But that was estrogen and this is testosterone, right? Well, the first study mentioned makes a point to say those in the treatment group experienced "no clinical or biochemical side effects." But another study, also examining the effects of testosterone, urges the hormone's cardiovascular risk be studied further. But more specifically, several studies have suggested, but not proven, that testosterone may contribute to disordered breathing during sleep. In one study, despite the expected effects on body composition, patients using testosterone slept one hour less than patients without the hormone. In addition, men with testosterone replacement had increased durations of hypoxemia--the deficient oxgenation of blood. Of course, this is a problem for men with COPD to begin with.
The quality of life erosion is a secondary concern when treating COPD--but it is a close second. Testosterone treatment seems encouraging but it is important to know exactly how safe the hormone is. Right now, researchers are still figuring that out.
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