Bombshell: Explosive Medical Secrets That Will Redefine Aging (18 page)

SS:
Because it wasn’t taught in medical school and I think doctors have been caught unprepared, and there is an embarrassment factor. So there’s a tendency to brush it off as junk science. Do you agree?

AM:
Yes, I do think that’s part of it. There is a widespread belief in the medical establishment that testosterone causes trouble, and it’s seen largely as a hormone for sex rather than for your heart, muscle, and fat and for your health in general. But sex has the biggest implication in terms of perception.

One of the areas in which I deal is sexual medicine. Doctors are supposed to be talking to people about sex but actually they are about the worst people to talk to anyone about sex, right?

SS:
Well, what doctor talked to you about sex when you were a kid?

AM:
Right. Nobody! I went to Harvard Medical; we were taught to be politically correct, as in when you took a sexual history you were supposed to ask without judgment in your voice, “Are your partners male, female, or both?” That’s about all I learned about sexuality in med school.

SS:
Luckily, many female doctors (primarily gynecologists) and antiaging doctors as well are now asking about sexuality.

Because you are a Harvard doctor you have credibility that can (excuse the term) slop over into orthodox offices making HRT [hormone replacement therapy] a viable choice. Your book
Testosterone for Life
was a true breakthrough. When you wrote about the merits of testosterone replacement, people listened. It essentially said: testosterone does not cause prostate cancer, and that a man could take testosterone if he had had prostate cancer.

Now you have new information saying that if a man has active cancer, he can take testosterone replacement. Can you elaborate?

AM:
Thank you. That’s essentially correct, but we have to be careful because it is not necessarily safe for
all
men with prostate cancer to take testosterone.

One group I do worry about is men with advanced prostate cancer, especially if they are on medicines like Lupron, which lowers the testosterone almost to zero.

SS:
You mean giving testosterone to these men is a waste of time because they are taking a drug to take
away
testosterone, so what’s the point of giving it to them?

AM:
Right. This is not good. Another group is men who happen to naturally have extremely low levels of testosterone. Most men diagnosed with prostate cancer do not fall into those two groups.

SS:
Where did the theory about testosterone causing prostate cancer originate?

AM:
In 1941, a urologist named Charles Huggins of the University of Chicago was doing studies on dogs with BPH (benign enlargement of the prostate). At that time it was known that around the 1900s, castration had been used to treat men who were in urinary retention, who couldn’t pee because of their big prostate. Castration caused their prostate to shrink, and some of these men were then able to urinate again.

SS:
Ouch!

AM:
Right. So Huggins and his colleague Clarence Hodges began performing castration on men with widely metastatic prostate cancer, hoping that the cancer would respond the same way as the enlarged prostate in dogs. They used a blood test called
acid phosphatase
to determine how these men responded, and sure enough, many of the men felt improved, and the acid phosphatase level fell, indicating that the cancer had regressed, or shrunk. Huggins went on to win the Nobel Prize in 1966 because his idea of castration helping with prostate cancer was the biggest news in oncology in the early 1940s. Everyone thought this was amazing and jumped on it, and Huggins became one of the most prominent medical doctors in the world.

SS:
When you say castration, you mean prostate removal?

AM:
No, it means removal of the testicles.

SS:
I am speechless. That’s a heavy-duty procedure.

AM:
In my training between 1984 and 1988, we did a lot of these operations.

SS:
Are they still castrating men today?

AM:
Yes, although in the United States, we tend to now use medicines to lower testosterone. Those medicines are relatively expensive, though, so in much of the world, removal of the testicles remains the standard treatment for metastatic prostate cancer. Lowering T [testosterone] to castrate levels definitely shrinks the prostate, lowers the blood test PSA, and can reduce bone pain if there are metastases in the bone. In some men, it can also provide a long-term successful treatment outcome, but in most cases the cancer eventually comes back.

The big fear about using T in men for health and symptoms, though, comes from a misunderstanding of what Huggins and his colleagues showed. The overly simplistic idea has been that since lowering T is a good treatment for prostate cancer, then it seems logical that raising T would be dangerous. It’s not that simple, though.

In my training at Harvard I had done some undergraduate work
with lizards showing if you manipulate testosterone and put it back into the right parts of the brain, these male lizards acted as though they were fine even though there was nothing circulating in their body and they went after females just like they should have.

SS:
Why manipulate the testosterone in the brain? Is it because there are testosterone receptors in the brain?

AM:
Yes! Some of the most important actions of testosterone stem from the fact that it is a brain hormone. I had been interested in testosterone, and had researched it in animals since the 1970s, but when I did my medical training and training in urology, all at Harvard, I was taught essentially that testosterone was dangerous, particularly for prostate cancer. Harvard had taught me never to give testosterone to men with elevated PSA or any suspicion of prostate cancer, for fear of activating the cancer. I learned that giving T to a man with prostate cancer was like pouring gasoline on a fire. I was also taught that low testosterone in men was rare, and that even if it were present, treatment with T was highly unlikely to be helpful for any symptom.

I don’t always listen so well, though, and I like to figure out for myself if what I’ve heard is really true. Because of my experience with the lizards I was curious about testosterone in men, and I started measuring testosterone in a lot of patients who came to see me with sexual symptoms, or who complained of fatigue or depressed mood. I was surprised to find quite a few with low T, since that went against my training. So I started giving testosterone to these patients and not only did their libido return, but they often said things like “I feel like myself again.” That was pretty impressive for me. But I still worried that some of these men might have hidden cancer of the prostate and that testosterone might promote its growth.

SS:
So you were taking a big chance.

AM:
It felt risky, since I didn’t know a single physician who was treating men in this way. Testosterone therapy had been primarily the province of endocrinologists, who prescribed T almost exclusively to men with severe T deficiencies, usually due to genetic problems like Klinefelter’s disease, or whose pituitary glands had been removed for tumors, or men who had lost both testicles and couldn’t produce any testosterone on their own. The idea of treating men who were otherwise healthy, and who had developed low T simply due to aging, was unknown to me at the time, although later I found a few sympathetic souls around the country who were doing the same thing. Nonetheless, I still worried that I might provoke a hidden prostate
cancer to grow in some of these men. Around 1992, I went to our national urology conference and I ran into one of my former teachers in the hallway who said to me, “Abe, I understand you are giving testosterone to men, and I don’t think you should do it.” He said, “I gave testosterone to a man and within a couple of months his PSA went up. I did a biopsy and he had cancer.” Well, I freaked when he said that, since that had been my biggest concern about T therapy. My treated patients were doing unusually well, but prostate cancer was the big bugaboo. This teacher of mine went on: “I don’t think you should be treating men with testosterone because of the prostate cancer risk. However, if you do, I strongly recommend you do a prostate biopsy first to make sure they don’t have cancer.”

I was sure I wanted to continue to treat with testosterone, but I took my teacher’s comments to heart, and when I returned from the meeting I went straight to my chief and told him I wanted to do prostate biopsies in men who were candidates for T therapy. He said, “Go ahead.”

Almost as soon as we started doing prostate biopsies in these otherwise normal men with low T—they had normal PSA, normal prostate exams—I found a few cancers. That was a shock. The traditional teaching had two parts. One was the caution that higher T was a cause of prostate cancer, and the other was that low testosterone was supposed to be protective against prostate cancer. In fact, almost everyone who trained in the field of prostate cancer was taught that men who developed severely reduced T early in life would
never
get prostate cancer.

A year or two later I presented this information to my colleagues, again at our national meeting. These men had no known risk factors for prostate cancer, and I had performed biopsies only because they had low T and I wanted to exclude the possible presence of cancer before I started T therapy. We found six cancers in our first thirty-three men, which at that time was considered a very high rate of cancer. That wasn’t supposed to happen if the T was low. At the end of the presentation, an internationally famous urologist stood up and said, “This is garbage! Everyone knows that high testosterone causes cancer, and low testosterone is protective. You guys just hit a few cancers you never should have found in the first place. I can guarantee if you do another hundred biopsies you won’t find another cancer.”

I thanked him for his comments and when I returned home, I continued to do biopsies and found more and more cancers in men with low testosterone. We wrote up our experience and submitted it to
the
Journal of the American Medical Association
[
JAMA
], and one day the editor called me and said, “This is highly unusual information you have submitted. It’s the opposite of what we’ve assumed for decades. We’d like you to accumulate more data, and if the numbers hold up, we will consider publishing it.” When we had prostate biopsy results in seventy-seven men with low T and normal PSA, and eleven of them had cancers, they published it. That was 1996.

SS:
This must have rocked the establishment.

AM:
It did. But I think no one really knew what to do with the information. Clearly we proved that low testosterone was not protective against prostate cancer. These men with low T had cancer rates of 15 percent, which was as high at that time as men who were supposedly at high risk, with elevated PSAs or a prostate nodule.

SS:
You know, I’m enjoying this because it’s been the thinking in antiaging for years, but the movement needed your research and, as I said before, coming from Harvard carries a lot of weight. It must be difficult for the “old guard” to let go of established ideas.

AM:
Right. From that research, I no longer believed low T was protective against prostate cancer. So I was curious where that idea had come from. I went back in the earlier journals and found that that theory was essentially based on
nothing
. It just fit neatly into a story line in which T was seen as the devil; high levels were bad, low levels were good. For years, urologists have seen themselves as the “protectors of the prostate.” My work and the conclusions I was drawing from our results were challenging to traditional ideas, and they didn’t like it. They saw me as kind of a “nut,” or let’s say they indulged me. Sometimes they would get angry.