Friday, March 16, 2012

Why link low testosterone to prostate exams?

Reader's are asking "do men with low testosterone really need prostate exams?"  It is a fair question.

First, our population is aging.  In 2010, one quarter of our population was between 45 and 64 years of age (the Baby Boomers) and another 13% are over 65.  In other words, 2 out of 5 American men are over 45, and are therefore at risk for low testosterone.

A 2006 study by Shores et al. showed that some 20% of male veterans over 40 had low levels of testosterone, and that low testosterone led to a 68–88% increase in chance of death over the course of the study.  Taken at face value, one out of every five men could be up to twice as likely to die because of low testosterone.  

Many studies show that low testosterone increases the risk of being diagnosed prostate cancer, and its severity, i.e. how quickly it grows, spreads through your body, and kills you.  According to the CDC, 1 in 6 men will have prostate cancer during their life, and some 10% of these will die each year.  Prostate cancer accounts for about 10% of the cancer deaths among men nationwide.  So if you are that one man in six with prostate cancer, and you have low testosterone, your chances of surviving get much worse the later the cancer is discovered.  Plainly put, having low testosterone puts a man at much greater risk for death from prostate cancer.  

Another fascinating article published by Albano et al (1997) shows the clear trend that men with less education are twice as likely to die of cancer.  Let's say this again: based on cancer deaths among a group of 120 million people, men with 12 or less years of education are twice as likely to die of cancer as those with a college degree or higher.

Now consider an analysis of the 2010 census, which showed that over 30% of Baby Boomers had less than 12 years of high school.  If we assume even fewer of our elderly population went to college, then we see that a huge percentage of our aging American men are at significant risk of dying from cancer.  If you are over 45, have low testosterone and did not go to college, statistics say that your chances of dying from prostate cancer are very high.  

Up to a million men could be saved from dying of prostate cancer by a simple procedure that takes under a minute to perform.  When a man goes to the doctor complaining of any symptoms that may point to low testosterone, the doctor must do a manual (or "digital" because you use your finger) rectal exam to help protect this at-risk population.  For any number of reasons, from lack of willingness of the patient, to insurance bureaucracy, to doctor's having to pack in too many patients, these tests aren't being conducted.  The law must step in and save these men's lives.   
If you knew that a million men could be saved, what would you do?  It isn't the American way to stand idly by.  We picked up our guns in the past to protect American lives.  Now, we should pick up latex gloves and take it like the men that we are!

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