The Truth About Testosterone

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By Dr. Ryan Smith

Ponce de Leon, the Spanish explorer, made a name for himself in the 16th century by searching for the legendary fountain of youth in what is now Florida. Today we use the legend of the fountain as a metaphor for something that might increase life span and reverse aging. Some advocates for testosterone therapy see it as just that, an elixir that can restore the vigor of youth.

With the rampant growth of “Low-T” centers and the marketing of testosterone and supplements claiming to boost testosterone, it’s hard not to feel like maybe we’re not man enough on our own.

The sales pitch for testosterone therapy sounds like every man’s wish list. Testosterone symbolizes strength, virility, honor, masculinity and for most men, invariably inspires visions of sculpted muscles and heroism.

If some testosterone is good, more must be better. When we hear the benefits of testosterone therapy—increased muscle mass, improved energy levels and libido, as well as a sharper memory and concentration—they seem too good to pass up. But, what is the truth about testosterone and what are its risks?

Testosterone is a hormone produced primarily in the testicles that helps maintain bone strength, fat distribution, muscle strength and mass, red blood cell production, sex drive and sperm production. Testosterone peaks in adolescence and early adulthood and declines about 1 percent per year after age 30.

It’s important to determine if low testosterone is due to age-related decline or a disease process. Hypogonadism is a disease that causes the body to be unable to produce normal amounts of testosterone and may indicate a problem with the testicles or pituitary gland.

A blood test is the only way to diagnose low testosterone, and even among experts there is debate over what constitutes low testosterone and when to initiate treatment. Testosterone replacement therapy may include gels, patches, injections, or pellets placed under the skin.

Some medications stimulate testosterone production as opposed to replacing it. These therapies are commonly used in younger men who have low testosterone and want to preserve fertility.

Why all the recent fuss about testosterone? Are men becoming “weaker” than prior generations?

A 2011 study by Northwestern University anthropologists showed declining testosterone levels after men achieve fatherhood. There is also evidence linking obesity and diabetes to a lowering of testosterone. Environmental exposures may also play a role. In a world where obesity, cardiovascular disease and diabetes are prevalent, and we are exposed to a multitude of environmental toxins, some might question how manliness can survive. One thing is for sure: sedentary lifestyles aren’t helping.

This creates a perfect storm for marketing the obvious cure, more testosterone! Testosterone prescriptions have risen 500 percent since 1993.

In some ways, we are at a similar place with testosterone therapy that we were with hormone replacement therapy for women over 20 years ago. When hormone replacement began for women, it was considered safe, but later it became apparent that it carried risks for certain cancers and cardiovascular side effects.

There may be dangers of testosterone therapy we don’t understand yet. The known side effects of testosterone replacement therapy include acne, changes in blood counts or cholesterol, infertility, and breast enlargement. Recent data appeared to link testosterone therapy to an increased risk of cardiovascular events like stroke and heart attack; however, vigorous analyses of these studies have called this assertion into question. In fact, many studies have shown that increased cardiovascular risk is associated with lower testosterone levels and restoration of normal levels may be protective. When you’re on testosterone therapy, your body stops its own production, so treatment is generally long-term. It’s important to discuss the risks and benefits of testosterone therapy with your physician.

Before resorting to testosterone therapy, for some men the real prescription may be for lifestyle changes, including weight loss, stress management, a well-balanced diet, more exercise and better sleep.

Significant gains from therapy are possible for men who have a medical need for testosterone replacement. For these men, testosterone can bring about improvements in health including potential lowering of cardiovascular risks, weight loss, strength gains, improved exercise tolerance, aiding in depressive symptoms, and restoration of sexual function.

If you have symptoms, discuss them with your doctor, who can advise you if you need a blood test. For those whose levels test low, testosterone therapy may be indicated. But don’t forget about the lifestyle changes you can implement with your physician’s guidance. Testosterone therapy can be important for men who need it, but it’s not the fountain of youth.

 

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