Testosterone: Which comic book character?

Batman or the Joker?

Okay, I admit it. I grew up in the day when comic books were comic books and the Hall of Justice cartoons were the thing. My memories of Batman were more in my imagination that the high tech filming of today’s movies. But what does that have to do with testosterone? Testosterone is the male hormone known not only for its part in building muscle, but also for various warnings of how it will ruin your health with various issues from prostate cancer to heart disease. The question is: Will testosterone turn you guys into the manly Batman or the sickly Joker?

If I posed this question to my kids, they would likely answer “both” only because I often offer either/or questions which are not really either/or. However, if taken in the right doses, it is probably closer to neither (my second favorite form of a trick question for my kids). Yes, high doses are used by professional athletes to add muscle to the physique because they really do exactly that. And yes, some research studies have indicated that testosterone supplements may be related to heart disease risk and prostate cancer. But… there are reasons that if your doctor prescribes testosterone, that you will be very unlikely to experience either of these outcomes.

On one hand, you won’t become The Incredible Hulk at the doses given today by integrative physicians. Your physician should test your levels first and be sure that you are truly low in testosterone. This does not have to be below normal range if you are experiencing “low testosterone” symptoms. Such symptoms include low sex drive or other sexual difficulties, fatigue, low energy, depressed mood, or weakness. The goal in the case with replacement is to raise your level back into a range that suits your body’s needs. Ideally, these symptoms improve and the lab tests show that your level is higher but not too high.

On the other hand, despite a lot of bad press and nay-sayers, the risks of “proper” testosterone replacement are low, especially in the scary areas of life like cancer and heart disease. As early as the 1940’s there were reports that testosterone therapy might increase prostate cancer risk (1). An article by Morgentaler, A (2) tells the tale of how this myth was perpetuated for decades. The more recent fear surrounds a recent study report claiming that VA (Veteran’s Administration) patients in the study who had received a testosterone prescription had a higher rate of heart disease (3).   This is another case of poor statistics leading to poor clinical conclusions. A true review of the data showed that the rate was actually lower (4). Furthermore, the all male study turned out to include 10% women (5). Another study (6) 2 months later suggested higher heart attacks rates for men on testosterone therapy was actually a poorly done study, so not very trustworthy (7).

To be fair, there are some minor effects that men should know about. Increasing blood counts, breast enlargement, acne and swelling are all possibilities. For men whose elevated blood count would pose a risk, this may prevent their treatment. However, there a several things that are clearly benefitted by testosterone therapy: Mood, erections, sex drive, muscle mass, bone density, and reduces fat mass. (see studies below: 8,9,10,11). So what is a guy to do if he wants to be like Batman? Not testosterone. But if he has health issues that his doctor believes might be related to low testosterone, checking a blood level and beginning therapy for a low level appear to be safe options.

This blog post is summarized from a Medscape article by Abraham Morgentaler, MD.   Dr. Morgentaler has cared for numerous men, providing testosterone replacement. Thus he can speak from clinical viewpoint and the research he had accumulated in his article, some of which I shared with you.

For the for full article, go to LINK and sign up for access to Medscape.


  • Huggins C, Hodges CV. Studies on prostatic cancer. I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. Cancer Res. 1941;11:293-297.
  • Morgentaler A. Testosterone and prostate cancer: an historical perspective on a modern myth. Eur Urol. 2006;50:935-939. Abstract
  • Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310;1829-1836. Abstract
  • Traish AM, Guay AT, Morgentaler A. Death by testosterone? We think not! J Sex Med. 2014;11:624-629.
  • Incorrect language. JAMA. 2014;311:306. http://jama.jamanetwork.com/article.aspx?articleid=1814192 Accessed May 29, 2015.
  • Finkle WD, Greenland S, Ridgeway GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PloS One. 2014;9:e85805.
  • US Food and Drug Administration. Citizen petition denial response from FDA CDER to public citizen. July 16, 2014. http://www.regulations.gov/#!documentDetail;D=FDA-2014-P-0258-0003 Accessed August 31, 2014.
  • Corona G, Isidori AM, Buvat J, et al. Testosterone supplementation and sexual function: a meta-analysis study. J Sex Med. 2014;11:1577-1592. Abstract
  • Amanatkar HR, Chibnall JT, Seo BW, Manepalli JN, Grossberg GT. Impact of exogenous testosterone on mood: a systematic review and meta-analysis of randomized placebo-controlled trials. Ann Clin Psychiatry. 2014;26:19-32. Abstract
  • Isidori AM, Giannetta E, Greco EA, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf). 2005;63:280-293. Abstract
  • Tracz MJ, Sideras K, Boloña ER, et al. Testosterone use in men and its effects on bone health. A systematic review and meta-analysis of randomized placebo-controlled trials. J Clin Endocrinol Metab. 2006;91:2011-2016. Abstract

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