“Replacing” a hormone the body normally makes when it is running low isn’t necessarily the safest thing to do. Women and their doctors learned this with estrogen after menopause. Now the FDA is sounding a warning that testosterone therapy can cause potentially dangerous blood clots in men. Such blood clots, called deep-vein thrombosis (DVT) and pulmonary embolism kill as many as 180,000 Americans each year, more than the number of people who die from breast, prostate, colon, and skin cancers combined. The new warning is not related to the FDA’s evaluation of possible links between testosterone therapy and stroke, heart attack, and death. Experts recommend testosterone therapy for men with a low testosterone level and one or more of the “classic” symptoms. For the rest? They get a talk-with-your-doctor recommendation. The warnings highlight that taking testosterone isn’t risk free. Combined with the lack of evidence about who really benefits, it means that the decision to start testosterone therapy is an individual one. A man must weigh the potential benefits against the potential increased risks of heart attack, stroke, and blood clots. If the balance tips in favor of moving forward, then trying testosterone is reasonable thing to do.
Archive for 2014
Four Harvard Health books won Wil Solimene Awards for Excellence in Medical Communication this weekend. They are Almost Addicted, by J. Wesley Boyd, MD, PhD, and Eric Metcalf, MPH; Chicken Soup for the Soul: Say Goodbye to Stress, by Jeff Brown, MD; Almost Depressed, by Jefferson Prince, MD, and Shelley Carson, PHD; and The Harvard Medical School Guide to Tai Chi, by Peter M. Wayne, PhD, and Mark L. Fuerst.
A few years ago, the U.S. Food and Drug Administration issued warnings that children and teens who took a common kind of antidepressant might experience suicidal thoughts. The point of the warning was to make sure that parents and doctors paid closer attention to kids taking these medications. But the plan may have backfired. A national team of researchers tracked antidepressant use among 2.5 million young people between 2000 and 2010. After the FDA’s warnings in 2003 and 2004, use of commonly prescribed antidepressants fell by 30% in teenagers while suicide attempts rose by 22%. The researchers concluded that the decrease in antidepressant use, sparked by worries over suicidal thoughts, may have left many depressed young people without appropriate treatment and that may have boosted the increase in suicide attempts.
A study published in this month’s Journal of Nutrition suggests that drinking caffeinated beverages, having the occasional alcoholic drink, and eating a healthy diet may help preserve memory and thinking skills long into old age. In particular, foods that are part of the Mediterranean diet—fruits, vegetables, nuts, fish, olive oil, and whole grains—show promise for preserving memory and preventing Alzheimer’s and other forms of dementia.
Researchers at Boston University and Massachusetts General Hospital have developed a bionic pancreas. In an early test of the device, reported online this week in the New England Journal of Medicine, it helped control blood sugar levels in 20 adults and 32 teenagers with type 1 diabetes who went about their daily lives without the constant monitoring and injecting that’s required with type 1 diabetes. Right now, this artificial pancreas is essentially an app that runs on an iPhone wirelessly connected to a monitor worn on the abdomen that continually checks blood sugar and two pumps, one for insulin and one for glucagon. The team that developed the bionic pancreas have begun a second round of testing, and hope to have a more sophisticated version on the market in five years. While not a cure, the development of a bionic pancreas represents a bridge that would let people with type 1 diabetes control their blood sugar with less hassle, and more safely, than they do now.
A new study that linked eating more protein to lower risk of stroke isn’t the last word on the subject. But that doesn’t make dietary protein any less vital, especially in older adults who are at greater risk for malnutrition and illness. How much protein is enough? Current guidelines for adults of any age recommend 0.8 grams of protein per kilogram of body weight. Do older people need more protein than younger ones? That’s still an open question.
Antidepressant medications have helped millions of people cut through the dark fog of depression. Many others try these medications but stop taking them, often because of side effects such as weight gain. A new Harvard-based study, one of the largest and longest studies of the connection between antidepressant use and weight so far, shows that the amount gained is usually small, and that it differs little from one antidepressant to another. Using citalopram as a reference, because earlier studies suggested that it is “average” when it comes to weight gain, bupropion was associated with the least amount of weight gain, close to none. Two others that also appeared to have relatively less weight gain were amitriptyline and nortriptyline. At the other end of the spectrum, citalopram caused the most weight gain. Even so, the differences between the drugs was small. The results of the study were published online this week in JAMA Psychiatry.
A study published in JAMA Internal Medicine this week found that men who used the erection-enhancing drug sildenafil (Viagra) were 84% more likely to develop melanoma, the most dangerous form of skin cancer, over a period of 10 years. That finding makes for an attention-grabbing headline. But it doesn’t tell the real story—that the study found an association (not cause and effect), that this hasn’t been seen in other studies of men, and that, even if it holds true, the absolute increase is small, from 4.3 cases of melanoma for every 1,000 men who didn’t take Viagra to 8.6 of every 1,000 men who took it. The take-home message is that it’s important to worry about melanoma—which is largely caused by getting too much sun—but not yet about Viagra and melanoma.
Dietary supplements are big business, even though few of the 85,000 products on the market have proven benefits. An article in JAMA Internal Medicine highlights a bizarre case of supplement overuse: a man, worried about memory loss, was spending nearly $3,000 a month on more than 50 supplements recommended by his “anti-aging” physician, plus hundreds of dollars more on other products he chose himself. Most of the products had no proven benefit on memory, and some may have contributed to the memory loss he was so worried about. had possible negative effects on brain function. People often assume that dietary supplements are effective, because of the claims they make, and are harmless, because they are “natural.” Not so. Unlike pharmaceuticals, which undergo extensive testing to prove they’re effective and safe before they can be sold, dietary supplements can be sold with without proof of effectiveness, safety, or purity.
If you want to stay healthy and mobile well into old age, start walking today—even if you’ve already edged into “old age.” That’s the conclusion of a report from the Lifestyle Interventions and Independence for Elders (LIFE) trial, published online yesterday in the Journal of the American Medical Association. Frail, inactive older people between the ages of 70 and 89 who started exercising were less likely to have become disabled over the course of a 30-month trial than a similar group who took part in workshops on healthy aging. Some older people they have passed the age at which starting an exercise program will do them any good. These new findings reinforce what other studies have shown: You’re never too old to exercise.