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Taking on Testosterone

By Karen Asp
Posted On Aug 09, 2016
Taking on Testosterone

If low testosterone is a reality for you, don’t despair. The hormone treatment for this symptom of male menopause is not just safe but it can help you live a healthier, happier life.

By Karen Asp


You can’t watch television without seeing advertisements galore for low T (the new lingo for low testosterone). Marketing for testosterone treatment is so prevalent, in fact, you would think it’s the greatest health threat facing mankind today. Rest assured, it isn’t. (That would be heart disease.) Low T is, however, becoming a bigger concern for men, and more prescriptions than ever are being scribbled to counter the issue. According to a study from University of Texas Medical Branch in Galveston, Texas, men’s testosterone therapy prescriptions have more than tripled over the past decade.

Yet testosterone therapy doesn’t come without controversy, especially after a 2013 Journal of the American Medical Association (JAMA) study that linked it to increased heart attack risk. This prompted worry about testosterone therapy, and some doctors have become hesitant to prescribe it. For most men, that worry is unfounded. Testosterone therapy, when used correctly, is safe, effective, and maybe even life-saving.

“Optimal levels of testosterone will protect your long-term health, helping to prevent heart disease, diabetes, body-fat gain, and muscle loss,” says Neal Rouzier, M.D., medical director of the Preventive Medicine Clinics of the Desert in Palm Springs, California, and author of How to Achieve Healthy Aging.Here’s what you need to know about low T (or hypogonadism), a symptom of andropause, otherwise known as male menopause. Testosterone is to men what estrogen is to women. A key sex hormone, it fuels all cells in the body, and one of its main jobs is to build muscle, says endocrinologist Florence Comite, M.D., who practices precision medicine in New York City and is the author of Keep It Up.

It strengthens bones, helps produce red blood cells and sperm cells, regulates sex drive, and is responsible for body-fat distribution.Research suggests that testosterone can aid the heart and even increase longevity. “In spite of this one study— which was poorly done and has since been rebutted by leading experts who have asked JAMA to retract it— decades of studies show a protective effect against heart disease and heart attacks,” Dr. Rouzier says. A 2014 study in the Annals of Pharmacotherapy has found that older men who receive testosterone therapy did not experience an increased risk of heart attack.

For men who already had an elevated risk of heart disease, testosterone was modestly protective against heart attacks.(Researchers note, though, that the latter needs to be interpreted cautiously, as those findings were based on analysis that involved a smaller sample and had less statistical precision.) Causes of low T are varied and can include the following: genetic issues, diabetes, heart disease, obesity, and certain medications. The most common of all, though? Advancing age Testosterone starts falling when men hit their thirties and decreases approximately 1 to 2 percent every year. Noticeable changes usually show up in the forties. “That’s when many men gain fat, especially at the belly,” Comite says. Other changes can include lack of energy, loss of body hair, muscle loss, decreased libido, erectile dysfunction, brain fog or memory issues, difficulty recovering after exercising, and more frequent injuries, aches, and pains.

By age 65, 75 percent of men will have experienced andropause, as evidenced primarily by low T. Declining testosterone levels, however, affect every man differently. “Factors like exercise, sleep, nutrition, stress, genetics, and even relationships can influence how much you experience symptoms,” says Comite. She says that severity can range from mild to severe. If you’re suffering, see a doctor who can rule out any other causes, then run a blood test to check testosterone levels. Here’s where it gets tricky: Normal testosterone levels for men are between 300 and 1,200 nanograms per deciliter (ng/dl), according to the National Institutes of Health. Many physicians treat only if levels fall below 300, which Rouzier finds inappropriate. “Just as physicians treat women for symptoms of menopause, not low estrogen, men should be treated for symptoms of andropause versus arbitrary numbers,” he says.

A man who has a level of 600 ng/dl but is denied treatment because of his number could still feel as lousy as a man with a level of 200 ng/dl who is getting treated. While you might hope to begin low testosterone therapy right away if you’re deemed a good candidate, lifestyle changes may be a more appropriate first step. “The success of testosterone therapy depends upon your health when you start treatment,” says James Katz, M.D., the president of Age Management Boston in Massachusetts. The better physical shape you’re in when you start taking testosterone, the more adequate protein and progressively smaller meals throughout a day), and regular exercise. Admittedly, those changes may still not be enough to raise your testosterone to optimal levels. It’s then that testosterone therapy can be a great boon.

The Endocrine Society recommends testosterone therapy to improve sexual function, well-being, muscle mass, strength, and bone mineral density in men who display low testosterone levels. Meanwhile, certain men shouldn’t use testosterone therapy—including those with prostate or (male) breast cancer, untreated severe obstructive sleep apnea, and a history of heart failure. If you qualify for treatment, talk with your doctor about the different methods of testosterone your number isn’t low enough, you can seek another opinion, Rouzier says. “You should also find a doctor who knows how to optimize your treatment so that your levels increase not just from, say, 200 to 300 but from 200 to 1,000 ng/dl,” he urges.

Once you start treatment, your red blood cell count will rise in tandem with your testosterone, which is why your doctor will need to monitor you regularly. That high blood count could cause your blood flow to become sluggish, says Comite. Testosterone may not turn you into a 20-year-old athlete again. But it certainly can renew vigor and vitality and put a new spin on aging. Woman have reaped the benefits of hormone replacement therapy for decades. Men, it’s time for you to catch up.