Grumpy Old Men: Maybe It’s A Question of Testosterone

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story supplied no information about the costs of treatment.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story did not provide any quantification of the benefits of treatment.  

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story mentioned the ongoing discussion about the association between levels of testosterone and prostate cancer.  It should have distinguished between what is known about testosterone levels and prostate cancer in general and how that compares with what is known about the use of testosterone replacement therapy and prostate cancer.

There are also other potential harms of testosterone replacement therapy including fluid retention, liver toxicity, polycythemia, etc.  Given these are older men, likely with comorbid illness and multiple medications already, the addition of another medication, especially a hormone with possible severe side effects, should not be taken lightly.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story did not actually present much in the way of evidence about the benefits of testosterone replacement therapy.  Although linking low levels of testosterone with a number of common complaints, it did not describe what is known (or not known) about whether or to what extent these resolve in a population treated with testosterone.

The story quoted one expert who wondered why testosterone wasn’t used to treat testosterone deficiency in old men when it is used for this purpose in young men.  The story should have included some balance with a quote from someone who might have insight into reasons why old men and young men differ.

In addition, the story stated that ‘…evidence is accumulating’ without providing additional information about the nature of the clinical evidence.  Instead, it is followed by anecdotal tales which is really the antithesis of what characterizes good ‘evidence’. 

Does the story commit disease-mongering?

Not Satisfactory

The story mentioned a wide range of complaints that aren’t specific to testosterone deficiency.  It failed to clearly explain that while these complaints (lack of energy, sexual dysfunction, mood changes, etc) may be associated with low testosterone levels, there are a number of other potential causes.

This story is, however, to be commended for not falling into the rabbit hole of using the term ‘andropause’ which was apparently popular at the meeting discussed.  

Does the story compare the new approach with existing alternatives?

Not Satisfactory

While mentioning a laundry list of symptoms that aren’t specific to testosterone deficiency, the story failed to mention that there are interventions for management of these besides testosterone.