NEWS
FROM THE NATIONAL WELL MEN PROGRAM
20 October 2004
Coverage has been given by a number of newspapers around the country to publication this week in the AMA’s Medical Journal of a government funded statistical research paper.
The subject matter is prescribing trends by region of testosterone replacement in Australia. It was accompanied by antagonistic but scientifically unsubstantiated comments and interpretation from the researchers involved.
This has led to a somewhat one sided reporting of the issues involved.
Please see following a copy of a Letter to the Editor which we are about to submit to those publications that we know ran the story eg the West Australian –“ Hormone Replacement Under Fire” and “Rush of Testosterone” Sydney Daily Telegraph both Monday 18 October.
Please note: Dr Zentner leaves for London later today where he will be giving two presentations for Doctors at the Royal College of GPs this weekend.
The first is on the use of testosterone in women and the second on the safety issues raised by failure to recognize testosterone deficiency - in the light of its now well documented impact on cognitive performance.
As a former Medical Director with Australian Airlines, Dr Zentner has a particular interest in the implications for flight safety, however the risks go across the board.
He recently presented a paper on the subject at the Annual Meeting of The Australasian Society of Aerospace Medicine in Adelaide.
Dr Zentner can be contacted on (08) 9474 4262/5638. Letter follows:
Letter for Publication.
Your article, “Hormone Therapy Under Fire” /West Australian 18/10/04, omits to mention that there is an increasing volume of refereed published medical literature* showing statistically significant links between low testosterone levels in men (and women) and an increased risk of several chronic illnesses such as osteoporosis, cardiovascular disease, diabetes type 2, Alzheimer’s disease and dementia.
At such a time, it is disappointing to see the Federal Government still funding moves that attempt to justify its stance of denying men equal access to subsidies for HRT under the Pharmaceutical Benefits Scheme ($30 million spent annually on women and still only $5.3 million on men.)
In this case taxpayers money has been used to fund statistical research into the levels of PBS prescriptions of testosterone supplementation in different regions of Australia in the years 1991 – 2001. (Figures for 2002 and 2003 although available have been omitted, one suspects because they do not serve the intended purpose of discouraging doctors from taking male hormone deficiency seriously.)
The factual statistical data that emerged from this survey has been interpreted and spiced up with speculative comments from two academic researchers. It is important to note that these two are also authors of the diagnostic guidelines which effectively restrict the subsidy of testosterone replacement for men under the Pharmaceutical Benefits Scheme, so they could hardly be considered either objective or independent in this matter.
These Australian guidelines establish qualifying levels of testosterone for subsidy at well below those regarded as acceptable throughout the rest of the international medical community.
The statistical “research” paper, (funded by Andrology Australia which in turn is a government funded body) and its supporting editorial, has recently been published in the AMA’s Medical Journal of Australia. Whilst the statistics are factual, the quotes used do not follow from the statistics and simply reflect the viewpoint and assumptions of the authors rather than being scientifically based.
For example, the allegation that “increased prescription rates are due to promotional activity rather than clinical need” is a sweeping claim that is totally unsubstantiated. To establish whether a clinical need is valid or not, some contact with the patient is surely necessary. This statement is pure speculation based on statistical data only, with no reference to the clinical condition of the actual men involved.
In summary, the community may well like to consider whether money spent on such an agenda driven survey would not have been better spent on genuine research into those chronic illnesses related to low testosterone levels that are set to significantly increase the health care burden on the community as our population ages.
Yours faithfully
Dr Adrian Zentner
* Reference papers:
Testosterone Levels Decline in Aging Men
Feldman et al. J Clin Endocrinal Metab 2002, 87:589-598
Low testosterone Linked to Depression in aging Men
Barrett-Connor et al. J Clin Endocrinol Metab. 1999 84:573-577
In Older Men Thinking Ability related to testosterone levels in most studies.
Morley et al. 1997
Barrett-Connor et al. 1999
Yaffe et al. 2002
Men with Low testosterone levels had lower scores on measures of memory and visual performance and a faster decline in memory
Moffat et al. 2002
Testosterone levels are lower in men with Alzheimers disease than in healthy men
Hogervost et al. 2001
Higher bioavailable testosterone associated with significant better cognitive function scores
Yaffe et al. J AM Geriatr Soc 2002
Higher scores on tests of verbal memory, visual memory and spatial perception associated with higher Free Testosterone
Moffat et al. J Clin Endocrinol Metab 2002
more…
Low testosterone is associated with increased factors for heart disease
Gyllenborg et al. 2001
Glueck et al. 1993
Stellato et al. 2000
Couillard et al. 2000
Low Testosterone independently predicts development of Type 2 Diabetes later in life
Oh et al. 2002
Low testosterone is associated with increased risk of heart disease
Phillips et al. 1994
English et al. 2000
Aging men accumulate intra-abdominal fat which is associated with low testosterone levels.
Balk et al. 2000
Katznelson et al. 1998
Tsai et al. 2000
Khaw and Barrett-Connor, 1992
Low Serum Testosterone is an independent predictor of Visceral Obesity in Men
Tsai et al. 2000
Khaw and Barrett-Connor, 1992