Replacement Therapy, Not Recreational Tonic Testosterone, Widely Used As a Lifestyle Drug, Is a Medicine and Should Be Kept As Such

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correspondence Replacement therapy, not recreational tonic Testosterone, widely used as a lifestyle drug, is a medicine and should be kept as such.

Sir — We read with great interest the News male tonics and remedies — most harmless, your Feature that there is a need for large- Feature “A dangerous elixir?” (Nature 431, but some as drastic as grafting goat testicles scale, long-term clinical trials to address 500–501; 2004) reporting the zeal with onto humans. Unfortunately, a certain several issues associated with testosterone which testosterone is being requested by amount of quackery is now perceived to be use. For example, testosterone therapy may men who apparently view the hormone as associated with testosterone therapy, and the be beneficial against osteoporosis, heart a ‘natural’ alternative to the drug Viagra. increased prescription of the hormone in disease and Alzheimer’s disease, but the Like Viagra, testosterone replacement recent years does little to dispel this notion. dangers remain obscure. therapy — with emphasis on the word Nonetheless, as your Feature highlights, Until we know more, both prescribing ‘replacement’ — is a solution to a very real hypogonadism is a very real clinical clinicians and the male population need to clinical problem. There is a distinction condition. It is characterized by abnormally be aware that testosterone, like any other between patients whose testosterone has low serum levels of testosterone, in medication, should only be administered declined to abnormally low levels, and conjunction with symptoms such as to patients for whom such therapy is individuals seeking testosterone as a pick- mood disturbance, depression, sexual clinically indicated. me-up. (As clinical and basic researchers dysfunction, decreased muscle mass and Richard D. Jones*, T. Hugh Jones*, interested in the effects of testosterone on reduced bone-mineral density. Kevin S. Channer† the cardiovascular system, we find that Heightened awareness of hypogonadism, *Hormone & Vascular Biology Group, Academic many clinicians and scientists also seem together with the increasing incidence of Unit of Endocrinology, Division of Genomic unable to make this distinction.) Perhaps associated conditions such as obesity, may Medicine, The University of Sheffield Medical it is not surprising that testosterone is in part explain the rise in testosterone usage. School, Beech Hill Road, Sheffield S10 2RX, UK turning into a lifestyle drug. But the inappropriate prescribing of the †Faculty of Health & Well-being, During the Depression, the United States hormone is likely to be a contributory factor. Sheffield Hallam University, was rife with travelling ‘doctors’ peddling We agree with the experts quoted in Collegiate Crescent, Sheffield S10 2BD, UK

DDT still has a role in the phase in alternative control strategies have to be refereed by Bush and Kerry’s (www.pops.int/documents/meetings/ peers, that is to say disingenuous politicians. fight against malaria inc4/en/inf9/inf9en.pdf). Such referees would no doubt insist on The Stockholm Convention came removing any shred of clarity and simple Sir — Your News story about the Roll Back into force in May this year. Its exemption truthfulness as contrary to accepted practice. Malaria campaign (“Struggling to make an allowing restricted and controlled use of The principle of peer review is an impact” Nature 430, 935; 2004) quotes me DDT according to WHO guidelines is a excellent one, but the practice is only as claiming that pressure from government good example of appropriate international as good as the reviewers. and other donors made spraying difficult regulation on a difficult dilemma. It is Robert Insall to push through politically. I am also quoted not a compromise but a solution, which School of Biosciences, University of Birmingham, as saying: “We have had very, very strong ensures that disease-control programmes Edgbaston, Birmingham B15 2TT, UK lobbying over DDT. We have had to give maintain access to a useful product, up.”The quotations give the impression while fully respecting the need to prevent that the World Health Organization (WHO) environmental damage from persistent has given up on DDT under the pressure of organic pollutants, such as DDT. Benveniste’s reputation lobbying. I believe this is misleading. Allan Schapira was not written in water When interviewed, I explained that Strategy and Policy Team, Roll Back Malaria we sometimes had to give up trying to Department, World Health Organization, Sir — The headline on your News story convince a specific donor to financially Avenue Appia 20, 1211 Geneva 27, Switzerland about the late Jacques Benveniste — support indoor spraying with DDT, if “‘Memory of water’ biologist dies after they flatly refused because of its perceived heart surgery” (Nature 431, 729; 2004) — toxicity and ecological hazard. This has reminds readers of the most controversial occasionally occurred in countries where Presidential candidates aspects of his career. His work cannot be the government wished to use DDT, and failed peer-review test fully appreciated by exploring only the there was evidence that it was the best second half of his scientific life. We should option for malaria-vector control. Sir — Peer review has had a bad press also remember his active participation in However, in general terms, the WHO has recently, but your piece by George W. Bush the discovery of platelet-activating factor, never given up in its efforts to ensure access and John Kerry (Nature 431, 240–243; a potent pro-inflammatory lipid-derived to DDT where it is needed. At meetings 2004) shows how valuable it can be. mediator (J. Benveniste, P. M. Henson of the intergovernmental negotiation The article is conspicuously full of and C. G. Cochrane J. Exp. Med. 136, committee on the Stockholm Convention unsupported (and unsupportable) claims 1356–1377, 1972; and J. Benveniste Nature — which seeks to control the spread of and deliberately ambiguous statements 249, 581–582, 1974). persistent organic pollutants — the WHO of the sort that never usually appear in Without omitting the more questionable has successfully defended the right of Nature,because no reviewer would allow part of his career, he deserves wider attention countries to use DDT for disease-vector them. Maybe all statements by politicians for this early work. His memory lives on. control, if no suitable alternative can be should be refereed by scientists. Bernard Rothhut found. The WHO also supports worldwide Of course, this idea also exposes the CNRS UMR 6198, UFR Sciences, Université de Reims efforts to develop alternative products and weakness of peer review. The article would Champagne-Ardenne, 51687 Reims cedex 2, France