Q&A with the doctor who pioneered modern testosterone treatment in America
The first thing Abraham Morgentaler learned about testosterone is that it’s a brain hormone. It was in a lab at Harvard, while an undergraduate in the late 1970s, where he had this realization: A castrated male lizard put in a cage with a female would not perform its mating ritual and would be uninterested in the female; but the same lizard, dosed with testosterone in the areas of the brain sensitive to testosterone, would — its dewlap coming out, head bobbing.
That is what he thought about when, about a decade later and a newly minted urologist, he began dosing men with testosterone. The patients were miserable, complaining of a lack of sex drive so severe it was ruining their relationships and lives. They were often coming for a second, third, even fourth opinion, after other specialists had been unable to help.
Could they be like the lizards? Could testosterone help them? But there was a problem. “In my training residency, I was taught that if a healthy man got an injection of testosterone today, he would come back in one month with prostate cancer,” he said.
At the time, testosterone treatment was limited to a few rare cases of severe hypogonadism, and no one — or no one that Morgentaler knew of — was even considering dosing men who had gone through puberty with the hormone. But his patients were so desperate that even as he discussed the risk of prostate cancer and demanded they get a biopsy to make sure they didn’t already have any cancer (an invasive, painful procedure at a time when anesthetizing the prostate was challenging), they were willing to take the risk.
So was he.
He started measuring patients’ testosterone levels, which he had never done in his training, and by trial and error landed on dosage and protocols that worked for them. He monitored their progress, and took note of the benefits they were reporting, which often included improved mood or better stamina. “I have to tell you, it was scary,” said Morgentaler, now a Blavatnik faculty fellow in health and longevity at Harvard Medical School.
“The benefits were obvious to me and I felt like I had this magic sauce that nobody else had. It didn’t feel right: I was too young a guy, not established well,” he said. “I worried that I was making a deal with the devil that the men were getting benefits now, but maybe I was putting them at risk, and they would get prostate cancer later on.”
Except, his patients weren’t getting sick. Not after a month, or many months. “The first indication I had there was something wrong with the story was my guys were doing well. I was monitoring them like crazy,” he said, noting that urologists “see themselves as protectors of the prostate,” so putting this particular organ at risk was especially concerning to him.
It took four decades, but the medical consensus now aligns with his clinical evidence: testosterone therapy in men with hypogonadism does not increase their risk of prostate cancer.
Read the full story: How testosterone fell out of favor in medicine — and how it came back