VA Educates Patients about Who Really Needs Testosterone Therapy

Veterans Increasingly Complain of ‘Low T’

By Annette M. Boyle

COLUMBIA, MO – Often spurred by advertising touting the benefits of testosterone supplementation for “low T,” veterans treated by the VA increasingly are requesting the replacement therapy.

Pitched toward men who may be experiencing reduced sex drive, lower energy, erectile dysfunction and other symptoms commonly associated with aging and certain medical conditions, the advertisements recommend use of testosterone patches or gels.

Warren Lockette, MD

Warren Lockette, MD

The VA has started pushing back against overuse of testosterone replacement therapy, however, especially now that the Food and Drug Administration (FDA) has changed labels on those products to caution about cardiovascular side effects as well as to emphasize the specific conditions testosterone is approved to treat.

“More and more of male patients, regardless of age, come to me and say, ‘I have low T,’” noted Warren Lockette, MD, former deputy assistant secretary of defense for health services policy and oversight and currently the senior associate dean for diversity and inclusion at the University of Missouri.

More than 85,000 veterans receive testosterone supplements through the VA.

Despite normal bloodwork, many patients still insist that their symptoms, such as lack of energy, fatigue, loss of strength, depression or erectile dysfunction are related to low testosterone levels, added Lockette added in his blog No Pablum Here. Yet, he writes, “most often, these symptoms are the result of the stresses of everyday life, not ‘low T.’”

Testosterone increases muscle mass and can boost mood and sexual functioning in individuals with underlying conditions that cause hypogonadism, but provides no significant benefit to others, according to Leonard Pogach, MD, national director of medicine at the VA.

Label Changes

In March, the FDA issued a safety announcement cautioning that prescription testosterone products are not approved for men who have low testosterone levels caused by aging and requiring manufacturers to note the approved uses on their labels. In addition, the FDA required the addition of label information regarding the possibility of increased risk of heart attacks and strokes in patients taking testosterone.

Further, the announcement advised healthcare providers to prescribe the therapy only for men who have disorders of the testicles, pituitary gland or brain that cause hypogonadism, as the benefits and risks in other populations have not been established. The FDA also required manufacturers to conduct a “well-designed clinical trial to more clearly address the question of whether an increased risk of heart attack or stroke exists among users of these products.”

Increasingly, there is evidence of significant risks from testosterone therapy for men who have age-related drops in the hormone or who have testosterone levels in the normal range, Pogach noted.

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Comments (12)

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  1. Elco says:

    This article mentions studies without citations that essentially fail to address the cases described in the introduction.

    There are as many or more studies dealing with relevant groups and more direct causation.

    It looks like the VA is using straw man arguments to save money.

    • John Bullock says:

      A more recent study listed on VA website at seems to contradict this premise, to wit:

      “A VA database study of more than 83,000 patients found that men whose low testosterone was restored to normal through gels, patches, or injections had a lower risk of heart attack, stroke, or death from any cause, versus similar men who were not treated. “

      • Anonymous Opionionated says:

        wonder what Warren Locket’s gonna think in about 30 years (maybe change his mind) when he is walking around in a confused haze of depression and anxiety, can’t please his wife or gf cause he can’t pull a boner or if he can’t it wilts… then to think of the next 20 years of his life not getting laid AND not getting the rush of
        Oxytocin – this is a good one; if one likes to feel really connected to another
        Endorphins – basically your good old heroin hit; feelin no pain after you cumm huh?
        Prolactin – put this in the water supply & guys wouldn’t be hittin on the first big boobed woman in sight if that’s their nature if not thinking of it; they would be much more productive
        Phenylethylamine – triggers all the happy thoughts love, laughter all that good stuff
        Serotonin – your bodies natural antidepressant


        • Robert Shine says:

          They also fail to mention that decreased testosterone levels can have a direct effect on the aging body amnd cause loss of bone mass. This is a major health concern for those of us who are beginning second careers and not just wanting to age gracefully. We are in need of maintained levels for energy and yes muscle mass which leads to weight loss and a better overall person. The government wants men like us to teach and that requires energy.We gave our younger selves to the government and now it is our turn.

  2. Mark Foor says:

    I had my T levels checked at the VA in Columbus, Ohio and they said i was good . The following week i went to a low T Center and yes my level was in the good range but not my free flowing T . Most Drs dont test for free flowing T. Normal range is 18-22 i was at 9.5 half of what is good . The low T Center drew the blood and had it sent to Lab Corp a respectable clinic . Now i have to pay out of pocket $200 a month to be fixed . The VA treatment i recieve for my Disability is Great but i cant say the same for other treatments im offered . Since ive recieved low T treatment along with working out 4 days a week i feel great . If your gonna offer Vets and Disabled Vets like me services then dont give us bogus services .

  3. Bob Handren says:

    My VA primary care doc told me in no uncertain terms that the VA does not provide testosterone replacement therapy under any circumstances even though I have a diagnosis of low T performed by a major VA Medical Center.

    Yet this article says 85,000 vets receive treatment.

    This isn’t the first time this particular provider has given me questionable information.

    I am rated at 80% disabled and supposed to be eligible for all health care problems. 10+ years ago I did. No longer. Looks like I should fight for this.

  4. Shayne says:

    A basic testosterone blood panel should include:
    -total test (total amount being produced)
    -free test (amount left to actually be used)
    -SHBG (sex hormone binding globulin. Testosterone is bound up by this and is rendered useless if the volume is too high)
    -estradiol (checks your estrogen levels which can can increase shbg)
    These 4 lab results will give you a total picture of what’s going on with your testosterone. The “range” they use is also very basic ranging from somewhere around 241-827 ng/dl. It’s not age specific and I’m sure we can all agree on the fact that an 18 year old should be producing more testosterone than a 90 year old. We (especially as veterans) all deserve the change at optimal hormone levels for out well being.

  5. mike says:

    I was prescribed testosterone from the va when they tested me and found my level at 33 and I was suffering from low energy. I was told that I should be between 241 and 827 and with testosterone therapy I was feeling great (in comparison). Now I am informed that I’m being cut off since I don’t have a pituitary problem and the therapy increases my risk of heart attack and stroke. Funny that the study on the 85,000 with no increase of risk was mentioned. I was informed that I have no say in the matter.

  6. John S. says:

    Two different test – a month apart and my bioavailable testosterone is low – the lab that tested clearly marked this result both times. My total T was 287 first test and 305 the second – which is low for a 46 year old male in good health who works out 5 hours a week in the gym lifting.

    I’m losing strength, no libido and I’m tired all the time. Other than my T levels my blood work is fantastic.

    I’m losing patience with the VA – my Doctor says that I don’t meet the criteria for HRT. He said he would refer me to Andrology but weeks later no response. I’m wondering if I’m going to have to go outside the system for treatment. It would be a huge financial burden but the longer I go like this the more I think it would be worth it.

    Quality of life isn’t something they seem to give a squat about.

  7. Gregory says:

    I don’t understand the problem. I was tested for low testosterone at 130. My PCP sent request to the pharmacy who denied the injections. If the PCP says I need it based on my blood work then how can the pharmacy come back and say NO they won’t fill it. I am a 100% service connected disabled veteran. The government needs to quit all this so called healthcare reform am doing fix the VA and Medicare. Fixing those areas would be healthcare reform indeed.

  8. Hank says:

    My VA clinic stated the same thing that they do not provide this type of therapy. I have noticed that since the implementation of Obamacare in 2011 that healthcare services have progressively deteriorated to the point of what one would expect in Cuba . The privately contracted clinic which I is my only choice lacks quality physicians and usually has nurse practitioners. I asked about Testosterone therapy again and they are looking into it.

  9. patrick says:

    The VA has gone the other way based on these “studies” veterans who have been prescribed benzos for 30 years-from the VA are being taken off of it in a rapid detox fashion. We are tired of getting thrown around one way or the other it is creating depressed patients with very unhappy lives. VA QUIT IT CUT IT OUT WE ARE PISSED!!

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