In this episode, Dr. Rena Malik, MD, hosts Dr. Abraham Morgantaler to unpack the controversy surrounding testosterone and its ...

why-doctors-are-hesitant-to-prescribe-testosterone-ft-dr-abraham-morgentaler

Why Doctors Are Hesitant to Prescribe Testosterone ft. Dr. Abraham Morgentaler

why is testosterone so controversial I'm convinced that if testosterone had a different name if you could take the molecule testosterone rebranded call it um Mo like these peptides right with the numbers right right like you call it molecule 1 2 3 4 five and you did a study and you showed all the different things that testosterone could do for you people would say this is the second coming we got to get on this for Health but testosterone comes with a lot of baggage everybody thinks they're an expert on testosterone you don't have to be medical oh yeah Wall Street Journal so the market goes up and there's like a Feeding Frenzy what do they say the Traders were filled with there was a a filled with testosterone today on Wall Street no they weren't right but a concept we think of testosterone we think of cheating athletes we think of bodybuilders we think of toxic masculinity y right Harvey Weinstein and and all that stuff testosterone testosterone is a bad person we have testosterone men and women have testosterone all of us do and it plays an really important role in our biology and it's not just us it's almost every vertebrate species anything with a backbone has testosterone right fish right we all have it and it's critical for for how our biology and our health and as as testosterone levels decrease as we get older we not only have symptoms but we're less healthy we're less healthy with more fat you know our lipids go off livers can get fatty our immune system is suppressed um it's not good and testosterone's actually shown benefits in terms of inflammation glycemic control and heart health absolutely yeah absolutely you know it's almost like a sociological experiment to look at what the data are what the facts are and then the attitudes of many in the medical community so a lot of people now get their testosterone from what might seem like less than uh reputable sources right so there's most towns and cities have one or more testosterone clinics somewhere in a less fancy part of town right rents are cheaper and the docks who hold themselves to these very high standards they think themselves as academic or you know the this is the key Medical Practice in town they look at the practices on the edge of town and they look down their nose at them and they say those guys are shady I've done a I do some medical malpractice expert witness stuff around testosterone you it's the scenario is always the same somebody was started on testosterone and then later on something bad happened right heart attack stroke prostate cancer but what's interesting is that um quite a few of these of the people who are being sued are these docks from the smaller practices at the edge of town and there's an underlying theme in these cases where people did not believe that they were reputable but why are they out there practicing is because in many cities you can't find a doctor to prescribe testosterone to you exactly because some of the docs think it's disreputable why do you think that it's so difficult to convince a primary care doctor or even a urologist T of times that testosterone is safe and effective and a viable treatment option yeah I'm giving a talk a couple of weeks on this what why do you think I mean I think that one there's a lot of misinformation that's been um touted which we've hopefully made ways in improving with the Traverse trial which I've talked about on my channel before I think that misinformation led to a lot of fear of heart disease of of uh blood clots of strokes and uh when in the reality is is far from that I think people are scared of of doing something they're not comfortable with I've spoken and interviewed unofficially quite a number the main resistance comes from the academic endocrinologists and the most amazing thing is that sort of at the top of that food chain if you will where the information comes from the folks who run like the guidelines for the endocrine society and I know many of them and they're good people solid people they've done the research most of them that has been most impacted ful in terms of showing how good testosterone is and how safe and yet when they get up in front of a microphone and talk about cases or whether somebody should treat they're almost all negative I've been in rooms with a couple of these people where we're waiting for something to start and they're sharing cases and they're competing with each other about how low somebody's testosterone was and yet they decline to treat it's like a badge of honor form so it's a very bizarre thing and I have a couple of thoughts about it um but what happens is that um you know with medicine it's it's hard to practice medicine there's so much information right whatever field you're in you're bombarded by information you're supposed to keep up with the latest and the newest you have a ton of patience you have to make it through your day you got all of that right yeah so you can't be an expert on everything it's impossible so what do we do is we we defer to those we trust and there's a couple of different kinds of trust one is people so they're the people that seem the most knowledgeable and they're often the authors of these studies and the other is often we defer to journals or other sources um not all journals but some journals we say if it's published in this journal or that journal it's got to be reputable right and they've gotten somebody to write an editorial about it that person the journalist selected that editorialist they really got to know their stuff and sometimes they're just wrong yeah and a lot of this is group think this isn't exactly it but it's related is that we've come to a place now you mentioned the Traverse trial so for for your listeners the Traverse trial is the largest ever randomized control trial of testosterone by far so until now the largest one was a thousand people and this one was over 5,000 it's a big deal and it as clearly as anyone could ever show in medical research no one cre in heart disease with testosterone and heart attack stroke or death no increase in prostate cancer prostate cancer sort have been where I've been fighting the good fight for all these years and it turns out and I mentioned Huggins in 1941 we're 80 years into this and the whole thing is BS there's one part that's true and everything else is wrong the one part that's true is is that if you deprive prostate cancer of androgens of testosterone like substances the cancer will shrink that's true yep and they have these super agents now like we call it ADT Androgen deprivation therapy these new agents I call them super ADT they lower testosterone even more people have longer lives they have longer progression without advance in their cancer true true true what's not true is that raising testosterone is a problem right it's taken me until this day I started this 1988 it's taken me until now 2024 for me to say to you with confidence that there's not one part of that story that's true before I would always say well I don't think it's true in this group of men that I treated and then I like I went to a slightly riskier population it wasn't true in them either but I don't know yet about like metastatic cancer whatever why have th treated men with metastatic cancer with Pro with testosterone and nothing special happened to them well we I was taught that these people would die within days to weeks if we raised testosterone no it didn't happen and now we have Travers The Chosen 5,000 Men followed for an average of 33 months that the rate of cancer was identical in both groups testosterone or Placebo and the number of highrisk cancers or high-grade cancers which are the ones now that we know to worry about first of all was extremely low in both groups but they're almost the same number also right it doesn't do it and what a lot of people including urologists don't fully appreciate but I think is really important is this so what does that study show it shows that they didn't develop they weren't diagnosed with prostate cancer when I started this crazy adventure of mine years ago offering testosterone to people and and I got in a lot of trouble around this too one of the things that that was going on was I lost my TR train thought but we'll get there so I used to biopsy men with test before I gave testosterone I was so afraid that I was going to risk having a hidden cancer grow that I did biopsies I ran into a um into one of my former teachers at the AUA MH our national Urology meeting you know we have SE several hospitals and one Residency program and the residents tell all the doctors at the other hospitals what everybody else is doing right so there's no secrets and I would talk in the operating room about my guys I was on testosterone how good it was and so I see one of my one of my former teachers from another hospital he says he I understand from the residence you're giving testosterone I said that's right it's so good they have this benefit that benefit he says stop you have to stop what you are doing you're going to give these guys cancer I said but what are you talking about it hasn't happened to me he said I heard about what you were doing so I decided to give one patient testostrone his PSA went up I biopsy him he has cancer so you better stop what you're doing and we talked for another little bit I wasn't going to stop cuz the the benefits were so incredible he said well if you're not going to do it then I suggest you biopsy the prostates of all these guys before you give them testosterone now that was a time you're not going to believe this we used to do biopsies without anesthesia it was very un like even without local without local oh gosh there was this belief and it's amazing how medicine so many of the things that we tell ourselves turn out to be garbage but we tell ourselves anyway so we didn't we we used to think there's no good way to anesthetize the prostate and most of the guys tolerate but it was really unpleasant for them and not everybody was and so I started doing this though I started I would say to the guys who had low levels of testosterone they wanted to be on it I said I can give it to you but we have to make sure your prostate is fine I'm worried about prostate cancer and I was not all of them were willing to do a prostate biopsy but many of them were MH and that was the price ofm Mission and what we found was the old story was that high testosterone was dangerous low testosterone was supposed to be protective my training part of the mythology of this whole thing was that Unix would never get prostate cancer now as a resident I would say to my chief resident say how do they know this about Unix because I didn't know any Unix yeah I don't know any either this absolute thing like how do they know this about Unix he said oh they studied the surviving Chinese Unix at the end of whatever the Ming Dynasty I don't know so that was a kind of BS answer but that's what it was but what we found out was that these guys were not protected at all as a matter of fact my first sort of big paper around any of this stuff was our biopsy results in our first 77 men they had normal PSA normal TI rectal exam I was biopsy them only because they had low testosterone and they wanted to go on treatment and I wanted to make sure they didn't have cancer these guys should have had a cancer rate of zero yeah but what we found is that one out of seven had cancer and at the time this was with only these six cores now you do usually minimum of 12 you do imaging you targeting something these are random biopsies just six little pieces 15% had can caner and we published that in the Journal of the American Medical Association we only had 77 men but 11 of them had cancer wow and we followed it up with another paper in 345 men um and so we have over 400 the numbers are the same and we know now from other prostate cancer studies that like the pcpt that there's a lot of prostate cancer and men with a PSA less than four going back to Traverse it's not just that they didn't have more cancer diagnosed it's that 15% of those men already had cancer in their prostates that wasn't detected they're walking around with it yeah but those cancers also didn't grow if they had grown with testosterone like we were taught was supposed to happen their PSAs would have gone up a lot the doctors would have felt nodules they would have had biopsies they would have been diagnosed so it's not only the T testosterone doesn't cause new prostate cancers it doesn't cause existing cancers to grow more than Placebo did that's powerful that's really powerful yeah so very few you get it now that I've told you your listeners will get it and and it's the reason that I now say with with as clearly as I can I think that whole story ends up being uh just bankrupted we've been living under a fairy tale for 80 years well and I think where very enco Centric in medicine meaning that cancer is so feared and so important to prioritize and I think it is to some degree but quality of life after a cancer diagnosis especially in a young man or young woman if she's got breast cancer or any sort of cancer that's hormone sensitive is is really important to think about yeah I couldn't agree more you know for your listeners sort of standard treatment for people with prostate cancer is bad is they undergo treatment where we lower their testosterone right so we call that ADT or Androgen deprivation therapy and then we have these newer I call them super super ADT agents lower it even more and the effects on men are profound there's some men who aren't B that bothered by it but everybody loses their sex drive just about everybody loses their ability to have sex but they lose muscle they gain fat a lot of men get diabetic there data that show there's increased cardiovascular risks but you know and I've had guys who had metastatic disease and who came to me and wanted treatment I said said that was pretty scary even for me to think of that I said why do you want this and I had one guy who said I'm so weak that when I get in the shower I can barely lift my arms to to wash my hair that's so sad his wife is with him so he's the used to be the most outgoing guy in the world he's got a Dillion friends we'd go out every night now he's like a shut in doesn't want to go out he refuses to drive says I don't feel up to it that's quality of life like and and all these guys said there's no point in my surviving longer in this state yeah this isn't life and that's what gave me the courage to treat these guys and they would bounce back and and I told them they could die within days or weeks and uh and they accepted that risk and I don't we didn't I published on uh about 20 of these guys I don't think we shortened a day of anybody's life and their quality of life improved they became people again if you enjoyed this clip of the Reena malic MD podcast make sure you check out the full episode with Dr Abraham Morgan Toler right here

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