Q. You recently wrote that testosterone does not increase the risk for heart attacks. But you overlooked the real risk of testosterone therapy: cancer!

I survived advanced prostate cancer seven years ago by having my testes removed because prostate cancer needs testosterone to grow. Most men with prostate cancer get leuprolide injections for several months to suppress testosterone production while they wait for radiation or surgery. They get off it as quickly as possible though, because men would rather die than give up sex.

A. For decades, physicians believed that elevated testosterone levels increased the risk for prostate cancer and heart disease. A large clinical trial published in the New England Journal of Medicine (July 13, 2023) contradicted that conviction. It concluded that testosterone replacement therapy (TRT) did not contribute to cardiovascular events. The same study also determined that men with low PSA levels were no more likely to develop prostate cancer on TRT than on placebo (JAMA Network Open, Dec. 1, 2023).

As you note, prostate cancer is frequently treated with androgen deprivation therapy (ADT). This can be achieved with drugs such as leuprolide or the surgical removal of the testes.

Q. I have been diagnosed with mild Alzheimer’s disease. The doctor wants me to use one of the two drugs now approved for this. I am very leery of them, especially the brain bleed problems. She also mentioned the Blue Zone books on diet and exercise programs because apparently, this can help slow the progress of the disease. Has anyone tried this?

A. Lecanemab (Leqembi) and donanemab (Kisunla) slow cognitive decline a bit but do not reverse it. Both can cause something called Amyloid-Related Imaging Abnormalities, or ARIA. That often indicates brain bleeding or swelling. In one study in China, nearly 10% of the participants experienced ARIA (Journal of Alzheimer’s Disease, Dec. 15, 2025).

There have been studies of diet and exercise to slow or reverse dementia. One, called FINGER, was conducted in Finland (Alzheimer’s & Dementia, March 2019).

In this large study, people either got regular health advice or a multidomain intervention involving personalized nutrition guidance, exercise, cognitive training, and management of vascular and metabolic risk factors, such as blood pressure and blood sugar. This intervention reduced the risk of developing dementia.

Q. I’ve been taking SleepEze Extra Strength for my insomnia. It contains diphenhydramine and when I take it, I start feeling really anxious and restless at the same time the drowsiness hits. It’s a very uncomfortable experience. I’m unable to stop myself from falling asleep, while at the same time, my mind is racing and my body is sore and restless. In some cases, I’ve had an anxiety attack before I fell asleep.

I would like a different sleeping pill after reading your article on the dangers of diphenhydramine. What do you suggest?

A. You may be experiencing paradoxical excitation from the sedating antihistamine diphenhydramine. It is estimated that 10%-15% of children become wired or restless after getting this medicine. Some adults also experience agitation.

You may wish to consider an herbal approach. Dr. Tieraona Low Dog is an expert on botanical medicines. She reports that ashwagandha (Withania somnifera) is often helpful for people who feel wired but tired. You can learn more about such alternatives in our “eGuide to Getting a Good Night’s Sleep.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 300 W. 57th Street, 41st Floor, New York, NY 10019, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”