Testosterone — it builds lean muscle, creates aggressiveness, burns fat, can increase strength and CAUSE A STROKE. That last one was not a mistype. For a long time we have known the dangers of hormone replacement therapy, ranging from permanent dependency on external hormone sources to causing some cancers (esp. those related to estrogen), but now we are seeing a new trend. Testosterone therapy is in vogue, thanks in part to the media and clever marketing targeting men with erectile dysfunction. A man may experience low testosterone at some point in his life, so what should we look for and how to we administer proper treatment?
Signs of testosterone deficiency are similar to those of pre/peri-menopausal symptoms in females, including: hot flashes, loss of libido, fatigue and depression. One of the driving forces in the study of low testosterone is the symptom of erectile dysfunction. This drop in testosterone later in a man’s life is termed andropause (the male version of menopause). Let’s take a quick look at the financial push for the recent testosterone therapy craze. In America, testosterone therapy is up near $2 billion, reported the New York Times. In fact, testosterone therapy, like androgel, carries a price tag of $500 per month!
Testosterone deficiency and diseases stemming from low hormone levels are estimated to cost the US $190 to $525 billion within 20 years. It is paramount we start to find the cause or some common factor to these hormonal declines.
How prevalent is testosterone deficiency?
A recent small study looked at men over the age of 45 and concluded that almost 40% were below 300 ng/dL (the lab cut off for testosterone). Another study looked at men between the ages of 45-74 and estimated it to be about 14%. The data is mixed on the prevalence, but there was a similarity. Most males that were testosterone deficient were overweight and likely to be insulin resistant. Both of these are contributing factors to low testosterone. We also know that there is a slow decline in testosterone in the aging male as well as the increase in sex hormone binding globulin (the protein that holds on tightly to testosterone and keeps it from acting on an organ).
In the US we have a very large obesity epidemic. According to the CDC, more than 1/3 of American adults are obese and the estimated annual cost of obesity was $147 billion in 2008. The increase in fat mass on our frames store an excess amount of an enzyme called aromatase. Aromatase (also called estrogen synthetase) is involved in hormone conversion, most specifically in the conversion of testosterone to estrogen. So the more fat tissue one has the more aromatase enzyme. Let’s take what we now and apply it to a real case. A 56-year-old male, 5’7 235lbs enters a medical office with ED. The doctor runs a blood hormone test and sees low testosterone. The diagnoses of “low T” is made and administration of testosterone begins. Let’s assume that some of the low levels of serum testosterone came from an OVER conversion of testosterone to estrogen because of the excessive amounts of aromatase enzyme in his fat deposits. What will now happen to the extra testosterone we have prescribed? If your answer is it will also be converted to estrogens, you would be correct 90% of the time. So what have we now done for the patient? Possibly given him a glimmer of hope for 30-60days until the body’s functions kick in again and now the patient is back to his pre-prescribed state or even worse. In my opinion, we need to work with the patient to reduce fat deposition, which will in turn lower the amount of store aromatase enzyme. Regulating sugar will decrease insulin resistance, allow the body’s endocrine organs to recover, and balance out cortisol production. Prescribing a cream in this situation is like patching a hole in a muffler with duct tape; it may work for a short period of time but will eventually melt, get gummy and create an even bigger mess than when we started.
“Testosterone therapy can increase cardiovascular insult by up to 40% in males”
Other body systems that are involved.
The liver plays a large role in the production and detoxification of these sex hormones. Our livers are constantly under attack from our diet, alcohol, environmental pollutants, and medications/drugs. Getting the different liver enzymes ran in your hormone replacement pre-screening is recommended. We need the liver to conjugate and remove hormone metabolites after they are used in our body. If this process doesn’t happen, the metabolites get recycled and throw off hormonal balance as the metabolites of hormones do not follow the same checks and balance systems and can “sneak” by without our bodies knowing.
Methylation also plays a large role in the activation and deactivation of hormones as well as the liver detoxification process. It may be necessary for your Doc to run genetic markers, such as MTHFR, to assess your genetic makeup and what role it may play in your treatment success.
Lets look at a few studies:
Now that we are educated on the basics of testosterone and the role it plays, let’s take a look at some studies. An article published in Andrology, titled “The effect of testosterone on mood and well-being in men with erectile dysfunction in a randomized, placebo-controlled trial”, looked at 140 men ages 40-70 with low serum testosterone. They were then administered testosterone therapy and monitored for overall mood and well-being. “Our findings show that the addition of testosterone to sildenafil (Viagra like compound) in men with ED and low serum testosterone levels was not associated with improvement in either well-being or mood.”
A recent article published in JAMA titled, “Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels” looked at the effects of testosterone therapy in the prevention of cardiovascular related disease and events. They monitored 1,223 patients that received testosterone therapy (for their low testosterone status) and compared them to a control group, 7,486 patients. At the end of the study, they concluded, “the use of testosterone therapy was associated with increased risk of adverse outcomes.” Those adverse outcomes were death and stroke.
This article is not to say that testosterone therapy is all bad or that low testosterone doesn’t lead to serious illness, because there are times when testosterone therapy is merited. The point I am trying to get across is that we cannot continue to take pills and rub creams on ourselves to chase a couple numbers on blood labs. We need to stop practicing “fad medicine” (the application of medicine that simply administers the latest trends for no other reason than to satisfy the public’s false perception of health due to clever marketing from large drug and nutrition companies). I urge you and your Doctor to begin searching for a cause rather than suppressing the symptoms, because in terms of testosterone therapy, it can lead to serious complications.
Why are we seeing such a rise in testosterone therapy
Big pharma follows phases and projects them to the public in what I term “emotional medicine”. As stated above, erectile dysfunction tends to be the driving force in the testosterone therapy craze. Erectile dysfunction plagues about 52% of the aging male population. At the age of 40, it is present in about 40% of the population; which is interesting because according to the American heart association, cardiovascular disease falls at 40.0% in the male population at 40. The CDC estimates diabetes type II at 32% for males in the same age bracket. We need to start paying attention to these co-conditions as being causative in nature.
For those men experiencing ED or “low T” status, please read the following carefully: low testosterone is rarely the cause for erectile dysfunction; in fact, normal levels of testosterone in aging men haven’t really been established. Those physician’s relying on this blood analyte the treat ED should re-evaluate their diagnostic protocols. Erectile dysfunction has more to do with nitric oxide, blood flow, overall cardiovascular health and balance in sex hormones rather than testosterone alone. Most studies state that in patients with ED, testosterone therapy increases desire but not function. If we ignore what we know about physiology and continue to use this therapy without probable cause, some scary statistics begin to arise.
In conclusion, I see testosterone therapy, for most, as a quick, short-lived cover up. There isn’t a single body process that just stops working or an organ that stops functioning “just because”. Looking further into genetics, liver detoxification, toxic exposure and gut health as they are essential and can provide clues to the “low T”. Education yourself so you can be an informed consumer in today’s politically driven healthcare system.
Moskovic DJ, Araujo AB, Lipshultz LI, Khera M. The 20-year public health impact and direct cost of testosterone deficiency in U.S. men. J Sex Med. 2013;10:562-569.
Farrell JB, Deshmukh A, Baghaie AA. Low testosterone and the association with type 2 diabetes. Diabetes Educ. 2008;34:799-806.
Spitzer M, Basaria S, Travison TG, Davda MN, DeRogatis L, Bhasin S. The effect of testosterone on mood and well-being in men with erectile dysfunction in a randomized, placebo-controlled trial. Andrology. 2013;1:475-482.
Shores MM, Kivlahan DR, Sadak TI, Li EJ, Matsumoto AM. A randomized, double-blind, placebo-controlled study of testosterone treatment in hypogonadal older men with subthreshold depression (dysthymia or minor depression). J Clin Psychiatry. 2009;70:1009-1016.
Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310:18291836.
O’Carroll R, Bancroft J. Testosterone therapy for low sexual interest and erectile dysfunction in men: a controlled study. Br J Psychiatry. 1984;145:146–151.[PubMed]
Buvat J, Lemaire A, Buvat-Herbaut M. Human chorionic gonadotropin treatment of nonorganic erectile failure and lack of sexual desire: a double-blind study. Urology. 1987;30:216–219. [PubMed]