Between two and four million men in the US alone suffer from below-normal testosterone levels, a condition known as hypogonadism.
It’s a problem that gets progressively more common as men age, though it can also strike men at any age for a variety of reasons. Unfortunately, very few men with below-normal testosterone are getting the help they need. It’s estimated that only 5% of the millions of men with hypogonadism are currently being treated, despite a booming business in testosterone replacement therapies of many kinds. (Sales of prescription testosterone products have soared more than 500% since 1993.)
This surge in the use of testosterone products may not be an entirely good thing. Testosterone replacement therapy is only appropriate and safe for men who have below-normal levels and who don’t have any medical conditions that could be made worse by testosterone, such as an enlarged prostate or evidence of prostate cancer.
As we’ll see, use of testosterone by men with normal levels is very risky. The symptoms of hypogonadism are often overlooked, because, in part, they are mistaken for ordinary signs of aging.
Men with below-normal testosterone experience the following:
- Low interest in sex
- Muscle weakness
- Small or soft testicles
- Erectile dysfunction
- Weight gain, particularly around the waist
- Reduced bone density
The enormous industry that has sprung up to capitalize on this problem has contributed to a dangerous rise in the unregulated sale and use of testosterone supplements. Far too many men are obtaining quick-and-dirty prescriptions for testosterone, and abusing the hormone because it makes them feel temporarily younger and stronger.
Myths and misunderstandings about testosterone abound. Here are the ones I hear most frequently:
1. Testosterone improves fertility.
False. Testosterone, particularly at the levels commonly used by athletes for performance enhancement, can effectively sterilize a man and cause his testicles to shrink and become soft.
2. Being overweight has nothing to do with testosterone levels.
Wrong. Extra fat on the body acts like a sponge, taking testosterone out of the blood and reducing libido, energy and other male-related characteristics. This is particularly true if the fat is carried around the belly or abdomen. Fat carried on the thighs or buttocks has less testosterone-draining effects.
3. Men can raise their testosterone levels by exercising vigorously.
The relationship between testosterone and exercise is complicated. Yes, moderate exercise can raise testosterone levels somewhat, but if exercise is extreme, testosterone levels can actually drop. It’s also true that low testosterone makes it harder to exercise, which can lead to a vicious cycle of inactivity and reduced hormone levels.
4. Male mid-life crises have nothing to do with testosterone.
I believe that many times when men say they are bored with their careers, their wives, or their general lot in life, they are actually suffering from low testosterone. I call this phenomenon “menoporche” because I’ve seen guys who think buying a hot new car will give them a shot of sex appeal or attractiveness, when, in fact, they would be much better off getting their testosterone level checked.
5. Testosterone supplements are safe because they have to be approved by the FDA.
Wrong. In fact, as of this writing, the government does not regulate the sale or use of products containing compounds that get converted into testosterone. Testosterone or testosterone precursors should only be used under a doctor’s supervision and testosterone levels should only be raised to normal levels.
6. Low testosterone causes depression.
True, but that’s just half the story. Most men don’t know that depression, or depressed mood, can lower their testosterone levels. Since many men don’t recognize signs of their own depression, or are reluctant to seek help treating depression, this is a significant problem for millions of men. Sometimes restoring testosterone levels can also alleviate symptoms of depression – and sometimes alleviating the depression with psychotherapy and/or antidepressant medications can raise testosterone levels.
7. Erection-enhancing medications (such as Viagra) work whether a man has normal testosterone levels or not.
Studies show that erection-enhancing medications work best in men with testosterone levels in the normal range. Testosterone provides the necessary urge to have sex that erection-enhancing drugs cannot provide.
8. Testosterone therapy is really just a form of cosmetic pharmacology – it’s just something middle-aged men try to make themselves feel young.
Wrong. Testosterone replacement for men of any age who have below-normal levels is a valid medical treatment for a condition with clear potential to degrade overall health and well-being. Failure to treat hypogonadism puts men at higher risk for frailty, osteoporosis, heart disease and, perhaps, Alzheimer’s disease.
9. Low testosterone is only a problem for old men.
False. Certainly the older you are, the more likely you are to have low testosterone, but this condition can affect any man, even teenagers. Conditions such as varicoceles, undescended testicles, and certain genetic problems can cause below-normal testosterone levels which need to be diagnosed and corrected as quickly as possible.
10. The only way to boost testosterone levels is with shots.
Several options are now available for testosterone replacement therapy, some of which work by coaxing the body to increase testosterone levels naturally rather than by dumping testosterone directly into the bloodstream one way or the other.
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.