Ask The Experts: Testosterone Therapy; Fish Oil; Shortness of Breath
Q. I have been told my fatigue and reduced libido may be due to low testosterone levels. My doctor has suggested a testosterone-boosting drug, but aren’t there safety concerns associated with these drugs?
A. Testosterone levels naturally decline with age, and the decrease is associated with problems such as diabetes, depression, bone fractures, and even a shorter lifespan. However, studies have shown mixed conclusions as to whether giving older men extra testosterone can improve their physical function. You are correct that there also are safety concerns about giving older men supplemental testosterone, as it could, for instance, trigger an enlargement of the prostate gland or fuel the growth and spread of any existing prostate tumors. It also is linked with an increased risk for heart attack—one study found a 30 percent increased risk of stroke or heart attack in a group of men recently prescribed testosterone therapy, and another found that men age 65 and older experienced a twofold increase in heart attack risk within the first three months of receiving a testosterone prescription. More recent research (Journal of the American Medical Association, Feb. 21, 2017) suggests the heart risk posed by testosterone might be caused by an increase in arterial plaque seen in men undergoing testosterone treatment. The Food and Drug Administration has mandated that testosterone therapy labels include a warning about its potential heart risks. If your doctor thinks the treatment may help you, be sure to ask for tests to confirm that your testosterone level is low before the therapy is prescribed.
Rosanne M. Leipzig, MD, PhD
Geriatric Medicine
Q. I take a fish oil supplement to boost my heart health, but a friend told me fish oil is often contaminated by mercury. Is she right?
A. Fish oil supplements shouldn’t have the same mercury contamination problem as some types of fish, because the fish that are most likely to contain mercury—including shark, king mackerel, and farm-raised salmon—aren’t used in supplement manufacture. That said, the increasing popularity of fish oil means that it is being imported from countries all over the world, and while the factories that produce imported oil are supposed to meet Food and Drug
Administration manufacturing quality standards, it’s possible some don’t. Brands of fish oil made in the United States are safe, as this indicates the fish were domestic, and virtually all of the processing, manufacturing and other parts of the supply chain are in the U.S. Opt for products labeled “USP Verified,” which means the product has been tested by the U.S. Pharmacopeia, a non-governmental standards-setting authority, for purity and potency.
Fran Grossman, RD, MS, CDE, CDN
Nutrition
Q. For the last few months, I’ve noticed I seem to be short of breath quite often. Although it’s worse when I’m exerting myself, I’ve also noticed it when I’m walking slowly. What could be causing this, and could it be serious?
A. If you are noticing that you become short of breath when you’re not engaging in moderate-to-vigorous physical activity—as your letter seems to suggest—you should mention the issue to your doctor. Several serious heart conditions can underpin shortness of breath, including heart failure, abnormal heart rhythms, and cardiomyopathy (a range of diseases that affect the heart muscle). Lung problems, such as chronic obstructive pulmonary disease (particularly if you have, or previously had, a smoking habit), and pneumonia are also possibilities, along with asthma (while it is considered a childhood disease, asthma is often diagnosed as a new condition in older adults). If your doctor thinks an underlying health condition may be causing your breathlessness, he or she can refer you for tests to evaluate the condition of your heart and lungs.
Bruce Darrow, MD, PhD
Cardiology
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