Being Smart About Testosterone
Testosterone clearly plays a major role in men’s health and fertility – but achieving healthy levels must be done the right way. As with anything, knowledge is power, and to reap the benefits of testosterone therapy you must learn a little about what testosterone is, how it works, and what can cause levels to sink below normal.
Low testosterone (hypogonadism) can be caused by many factors, all of which play out against the normal steady decline in testosterone levels with age. Tumors on the pituitary gland (which controls testosterone production in the testicles), problems with the testicles themselves, injury, infections, and being overweight can all cause testosterone levels to drop below normal. Excess body fat does this because testosterone is normally broken down in the body’s fat cells; hence if you have a lot of fat, your body breaks down testosterone extra-quickly, leading to a deficiency. And, as mentioned above, abdominal or “belly” fat has a greater capacity to convert testosterone to estrogen than other types of fat.
Another risk factor for hypogonadism that has only recently come to light is diabetes. A strong relationship has been discovered between impaired glucose tolerance, which is a cardinal feature of diabetes, and low testosterone levels. It appears that the high blood sugar levels and/or low insulin levels characteristic of diabetes harm the cells in the testicles that are responsible for making testosterone. A very recent study of 221 middle-aged men confirmed this finding: The men most likely to be diabetic also had the lowest testosterone levels.
The reverse may also occur: low testosterone levels may decrease insulin sensitivity to lower muscle mass, thereby making diabetes worse. Because diabetes, particularly adult-onset diabetes, has been steadily rising as a health problem in most developed countries, the prevalence of hypogonadism associated with this disorder will likely rise as well in coming years. We’ve already seen a rise in a condition known as metabolic syndrome, which is a pre-diabetic state, among men with low testosterone levels, abnormal lipid profiles, insulin insensitivity, and weight gain around their middles. In fact, one of the clearest signs of both low testosterone and a tendency toward diabetes is abdominal fat. If your waist is larger than 40 inches and you tend to carry excess wait in your middle, as opposed to your thighs or buttocks, you may be at risk for both conditions.