Testosterone: Over-rated or Under-prescribed

In recent years, the number of men taking testosterone has sky-rocketed. We are now bombarded with ads featuring not only the happy Cialis “Couple-in-a-Tub”, but testosterone gels and creams. It is almost impossible to estimate just how many men are using some form of testosterone to enhance everything from their work-outs, to sexual function and fatigue. It is important for the general public to understand that just because it says so on TV, it doesn’t mean you need it. In fact, you may be wasting your time and money, or even making your symptoms worse. In the past, men may have shied away from testosterone therapy for fear of prostate cancer, blood pressure problems, or just because they were too embarrassed to talk to their doctors about it. Today, with the media hype and access to these products, it is often the wrong men who are taking this hormone. However, testosterone is essential for a man’s quality of life, muscle tone, energy, sleep, bone density, and sexual function. Low testosterone has been linked to depression, irritability, and osteoporosis. It is the primary source of libido for both men and women. It gives vitality and virility. It really is a big deal!

Testosterone is primarily made by the Leydig Cells in a man’s testes in response to LH from the brain. Young men usually produce 5-7mg/day, with the highest production in the morning. Yet, testosterone is only one of several essential hormones for male health. Other hormones that need to be in balance with testosterone are progesterone, estradiol/estrone, pregnenolone, DHEA, thyroid, insulin, HGH (human growth hormone), and cortisol, to name a few. Cortisol is a mammal’s main stress-response hormone. While testosterone is an “anabolic” steroid, cortisol is “catabolic”. The constant stress of modern life has caused many men to have lower testosterone levels today than their fathers had at their age. Whether real, or perceived, this stress affects the human body by shunting many of the building blocks that would normally be used to make testosterone into making more and more cortisol. While men today may have a lower testosterone than before, they have to deal with more stressors. Many men in their 40’s and 50’s have younger children than the previous generation. They are looking at looming college tuitions while also coaching little league. They are part of the sandwich generation, with the added stress of aging parents. More is being asked of them at an age when men were previously able to slow down, and they find themselves in a society that values youth above experience. Unfortunately, their wives are often going through menopause themselves, adding even more stress. Mars and Venus are indeed floundering in the same boat. Small wonder many turn to testosterone- if just to fight the fatigue of it all.

Recent studies have alleviated the fear of testosterone replacement causing prostate cancer. Judicious following of a patient’s serum PSA levels, and regular prostate exams have made replacement therapy an acceptable alternative to the usual aging with frailty. When needed, testosterone replacement therapy can be life-changing. The emphasis here is on the term “when needed”. This can only be determined by lab tests. Usually some combination of blood or saliva testing is advised to assess the whole hormonal picture. You cannot take testosterone out of context when looking at a man’s health. For

example, testosterone levels may be normal, but what about the estrogens? The body uses an enzyme called aromatase to convert testosterone to estrogen. This is important because too much estrogen, especially in the form of estrone, is not good. Estrone has been linked to prostate cancer, and increased breast tissue in men. If this person takes testosterone without addressing his aromatase issue, his body may take the extra testosterone and make even more estrone. Are there other factors affecting his testosterone? If stress and cortisol levels are not addressed, any hormone therapy could not only be useless, but make the body even more stressed. Low testosterone can result from aging, diabetes, obesity, liver disease, excessive alcohol intake, smoking, and certain medications. Poor diet and lack of exercise contribute to low testosterone, as does lack of sleep. A recent study showed that young men with normal testosterone levels, when subjected to sleep deprivation of only 5 total hours of sleep per night, had 15% lower testosterone levels in only 1 week. How many men pride themselves on being able to “function” on only a few hours of sleep?

Unfortunately, we often hear of testosterone supplementation in the context of young athletes who don’t need it and are using it for performance enhancement. These athletes are living in the moment, as young people often do. They either don’t care, or don’t want to think about the damage they are doing to their own bodies. They may suppress their own, endogenous, hormone production. They may develop excess breast tissue, or shrink the size of their own testes. They often have high blood pressure, acne, and aggression.The detrimental effects of anabolic steroid use will follow them later in life. This media scrutiny can sometimes put testosterone replacement therapy in a bad light, and may keep men who truly need testosterone from considering this important hormone.

At the end of the day, we all have to take our health into our own hands. If aging without frailty is important to you, testosterone replacement therapy as you age should probably be a consideration. A physician trained in the evaluation and treatment of hormone deficiencies and anti-aging medicine is uniquely positioned to guide you to better health and improved quality of life for the long run. Proper testing is essential. Specialized saliva and blood spot tests may be found at your compounding pharmacist’s or doctor’s office. Serum blood tests are ordered by a physician. Only after the proper tests have been evaluated, is it appropriate to prescribe any of these hormones. On-going testing is usually done every few months, depending on the patient’s needs, once hormone replacement therapy has begun. Further information and referrals may be found at A4M.com (American Academy of Anti-Aging Medicine), or simply ask your compounding pharmacist.