Of course, the claims are always made by an organization that wants to sell you the cure. That’s why Bloomberg Businessweek reports that sales of testosterone drugs could hit $5 billion by 2017; 3 percent of American men aged 40 and older have been prescribed testosterone replacement therapy. That figure doesn’t count the millions who may have tried an over-the-counter supplement. The American Diabetes Association reports that more than 13 million men have low testosterone levels
Why the concern over low testosterone? The advertising about the condition surely stimulates some panic, and the symptoms are certainly ones that no man really wants.
Men with low testosterone exhibit a host of uncomfortable and embarrassing symptoms, including low sex drive, depression, erectile dysfunction, fatigue, inability to concentrate or remember things, moodiness, irritability, loss of muscle strength, and increased body fat. Other symptoms include a decrease in hemoglobin, thinning of the bones and a feeling that you’re missing something. The last condition usually stems from watching the advertisements, where testosterone therapy is promoted as a fountain of youth that will bring success, money and beautiful women.
In a culture that exalts power, vitality and sexual attraction, the loss of those attributes means men who suffer from low T are losers, or so the advertisements would infer. That is a powerful message and an extreme burden to bear if it is internalized.
A Natural Side Effect of Aging
Here’s the thing: Age plays a major role in the amount of testosterone in the body. There is a natural decline after age 30 that continues to the end of life, roughly decreasing by 1 percent each year. That is the natural rate, but the rate of decline can be exacerbated by injury, chemotherapy, metabolic disorders, tumors, medications, unspecified illnesses, alcohol abuse, cirrhosis of the liver, HIV/AIDS, kidney failure, sarcoidosis, Kallman syndrome (a problem with a gland in the brain that controls hormones), type 2 diabetes, obesity, aging, extreme weight loss, excess estrogen, primary hypothyroidism, radiation exposure or brain surgery, and head trauma.
There is also a disease called hypogonadism in which the body can’t produce normal levels of testosterone. This is tied to abnormal function in the pituitary gland that controls the testicles, or a problem within the testicles themselves.
That’s by no means a complete list and points out that the world seems to be working against optimal testosterone levels in older men.
It is estimated that 40 percent of men aged 45 and older have low testosterone. One difficulty in diagnosing it is that levels vary during the day and are affected by medications, illness, alcohol consumption and nutrition.
Study Raises Questions
The relentless drumbeat of low testosterone warnings is tempered a bit by a report issued by the American Medical Association. That report declared that men who had previous heart problems and low testosterone levels risked serious heart problems, stroke and even death by trying to boost their T-levels.
The report, done in conjunction with researchers at the University of Texas at Southwestern Medical Center in Dallas, studied more than 8,700 men with diagnosed low testosterone levels who had an angiogram to look at their arteries. That result found that the 7,500 men who did not get testosterone treatments had a ratio of one in five with bad cardiovascular conditions that caused stroke, heart attack or death.
But of the group that did get testosterone treatments – 1,200 men – one in four had a stroke, heart attack or death, which represents a 30 percent increase over those who did not. Thus, taking a testosterone treatment is a real roll of the medical dice, at least for older men who have other problems -- those in the study were older veterans. Whether it affects young men in the same way is still up for debate.
Diagnosis and Treatment
Low testosterone is determined by a blood test that will sample the blood at different times of the day as levels change. The highest testosterone level occurs at 8:00 a.m. for most men.
If there is a diagnosis of low testosterone, doctors have several options for treatment. These include:
1) Injections: This is an injection of testosterone done every 10 to 14 days.
2) Testosterone patches: Like smoking cessation, these are worn every day and applied to different body parts, including the arms, back, abdomen and buttocks.
3) Testosterone gels: These are daily applications to clean and dry skin on the upper back and arms. Extreme care has to be taken to make sure it is not accidentally transferred to another partner.
4) Skin implants – These are pellets that are tucked under the skin every two months.
There is currently no oral medication formally approved by the Food and Drug Administration in the United States for low testosterone.
Of course, no treatment designed to increase hormone levels comes without potential side effects. For men, these include acne development or extremely oily skin; ankle swelling caused by fluid retention; prostate problems, which can cause difficulty urinating; breast enlargement and tenderness in that area; sleep apnea; testicle shrinkage; and skin irritations. There may also be an increases in PSA levels (the prostate-specific antigen), an increase in red blood cell counts and a decrease in sperm production.
Regular monitoring by a trained physician is essential when taking the supplements. Doctors will monitor PSA levels and do a prostate examination, and hematocrit levels will be checked to make sure red blood cell counts remain normal.
Ultimately, every individual is unique. That’s why concerned men should have a frank talk with a doctor to share concerns about testosterone levels. Taking the test may indicate a problem, and it will, at least, focus on areas of diet, exercise and lifestyle that can be improved if the tests don’t indicate a specific hormone problem. That may be one benefit of a low testosterone test that ultimately proves effective.