Many men watch as the women in their lives battle the changes of menopause. It isn’t a huge surprise that “the change” comes to every woman when she hits a certain age, right? Who hasn’t heard about menopause and hormone replacement for women? But testosterone therapy still remains a mystery for many men.
Men reach this place somewhat unexpectedly. Andropause, the decline in testosterone production from a man’s testicles, can be quite sneaky. Low testosterone is sometimes even seen in men in their 30’s and 40’s. Symptoms include:
- lack of energy
- decrease in libido (sex drive)
- decrease in strength of erections
- loss of strength or endurance
- disrupted sleep
- falling asleep
- decrease in motivation
- drop in work performance
I know many of you reading this are thinking that “this sounds like me, but what do I need to do about it”? To make the diagnosis of andropause, it is well accepted that with a testosterone level under 200, a man is considered to have low testosterone. But the normal lab range for testosterone is 200-1100. However, most physicians who practice integrative medicine feel the testosterone should be above 600 to achieve optimal health.
There is certainly much heated debate about testosterone for men. Most recently, the debate about testosterone being linked to cardiovascular disease. There is much research that continues to be done on this matter and in my opinion testosterone is good for men. Here is a great review article from 2015, which shows no correlation between testosterone and cardiovascular disease.
Even in the 1990’s, studies in major journals already showed us that men with low serum testosterone had higher body mass index (BMI), higher systolic blood pressure, higher fasting and 2-hour blood sugars, higher triglycerides and LDL. There is significant evidence in the literature that testosterone is incredibly beneficial for men.
What I hear from a lot of men is that they are just really tired. They nap a lot. They don’t play with their kids (or grandkids) and it feels like a chore when they do. They used to be salesperson of the year, but could care less now. But erections are good. This is mainly what people think about when they think of testosterone. Many people believe that the main effect of testosterone is sex drive and erections. That is just the start of what testosterone can do, and many men don’t suffer with erection problems until the very end. They had the symptoms of low testosterone for years, but only when it affected their erections, did it signal a red flag for them.
So what if you have low testosterone? Does it really matter? Well, much research has come out about testosterone therapy. Research tells us that testosterone helps with many aspects of health such as:
- Sexual function
- Maintaining bone and muscles – testosterone improves bone mineral density which helps us to have strong bones and prevent osteoporosis
- Improving cholesterol for some
- Improved memory
- Building muscle and decreasing fatty tissue
- Improving blood sugar (fasting glucose, insulin, and HgA1C)
- Decreasing risk of cardiovascular disease
The good news is that your testosterone level can be restored using a number of methods, such as:
- Troches (lozenges that go in cheek)
- Injections (testosterones cypionate and ethyloleate are most commonly used)
- Hormone Implants (hormonebalance.org)
Everyone asks me which method of replacement is the best. Everyone is different. Some people respond great with gel. Some feel their best with injectables, and some like the convenience of pellets. I also want to address a belief that most health professionals have long regarded as truth – that testosterone increases your risk for prostate cancer or worsens it if you have it. More than 5 years ago, I had the opportunity to attend training with Dr. Abraham Morgentaler, a Harvard urologist, who has done a great amount of research on testosterone therapy in men.
When he started treating men with testosterone, he found that they had more energy, they slept better and felt more alive. One day, he ran into one of his former attendings (doctors that instruct during residency) who had heard he had been prescribing testosterone to men. This doctor told him that he should stop, because he had given someone testosterone and within a year was diagnosed with prostate cancer. “If you are going to continue to treat men with testosterone, and I recommend you don’t, you should at least do a biopsy [prostate] to make sure they don’t have cancer.”
Well, it really bothered Dr. Morgentaler, coming from a man he respected, so he followed his suggestion and started to do a prostate biopsy before initiating testosterone therapy. Of the first 33 men with low testosterone he biopsied, with a PSA (prostate specific antigen which is a blood test we use to watch for prostate cancer) under 4 ng/mL (which is considered normal) and normal rectal exam to check the prostate – six had cancer. By the time he reached 75 patients, he had 11 patients who had prostate cancer (14%).
In 2006, Dr. Morgentaler and Dr. Rhoden published a larger study of prostate biopsies of 345 men with a normal PSA. The cancer rate was 15%, which was similar to the previous study. What they also found in the study was that the lower the testosterone, the higher the risk for prostate cancer, and specifically, more aggressive prostate cancer.
As with any medication, there can be side effects. These are usually infrequent if monitored appropriately. These should be discussed with your doctor at the time of your visit. Testosterone replacement to restore optimal levels is nothing to fear. As doctors, we learned little, if anything about helping men optimize testosterone levels. So, do not be surprised if your doctor is uneasy about prescribing you testosterone.
So if you or someone you love have any of the above symptoms, do not hesitate to ask you doctor about getting your level checked. Don’t assume that because you are young, that low testosterone cannot affect you. One of the men in his mid 30’s says that testosterone saved his life. So, if you are a man who has low testosterone, who wants to have kids in the future, testosterone therapy may not be for you. Talk with you doctor about other ways that you can improve your testosterone levels.
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