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THE LOW TESTOSTERONE EPIDEMIC
By Waldo Acebo, MD
By the age of 80, a man’s testosterone level may only be 20% of what it was in his youth. This decline in testosterone occurs gradually, starting as early as his mid-30s, and can result in an increased risk of life-threatening illnesses such as obesity, diabetes, and heart disease.
Recent studies have demonstrated that hypogonadism [low testosterone] in men may be more prevalent than previously thought, is strongly associated with metabolic syndrome, and they are a risk factor for type 2 diabetes and cardio-vascular disease.
Testosterone deficiency can also lead to a number of disturbing symptoms, including loss of stamina and lean muscle mass, reduced libido, anxiety, depression, and cognitive decline. Known as the andropause, these changes are the male equivalent of female menopause. Unlike menopause, however, the drop in testosterone is so gradual that the symptoms of Andropause appear over a longer period of time and are often ignored for a while or are attributed to “getting older.”
A recent study found that men with lower testosterone levels were more likely to die from cardiovascular disease and all causes compared with men who had higher levels. Another study reported that there is a higher prevalence of depression, coronary heart disease, osteoporosis, fracture rates, frailty, and even dementia with low testosterone states.
Testosterone and Depression
Researchers have found that patients with depression had significantly lower testosterone concentrations than men without depression. It has been suggested that older men with depression may benefit from systematic screening of testosterone levels and testosterone supplementation where appropriate. In my own practice, I have seen both younger and older men with low testosterone levels and depression improve remarkably after testosterone supplementation. Other studies have shown an improvement in depression with testosterone therapy in patients who are unresponsive to conventional treatments.
Testosterone and Mental Capacity
Testosterone supplementation clearly seems to be beneficial for proper male mental and verbal function. Several studies have shown that decreased serum testosterone levels appear to adversely affect verbal memory in healthy young men. Short-term testosterone administration exerts a beneficial effect on spatial and verbal memory and enhances cognitive function in healthy men. In fact some well known doctors use sublingual testosterone before giving a lecture, to improved focus, attention and memory.
Testosterone and the Heart
Lower testosterone levels are associated with reduced pumping ability of the heart. A clinical study in men with ischemic heart disease and low testosterone levels reported that exercise time and the time to development of ischemic changes on a treadmill test were both increased with testosterone-replacement therapy.
Testosterone and Diabetes
Growing research suggests that low testosterone levels may be intimately linked with insulin resistance and its related conditions of metabolic syndrome and diabetes. Low Testosterone promotes abdominal obesity in aging men. Recent research suggests that between 20% and 64% of men with diabetes have low testosterone levels; older men appear to be particularly susceptible. Scientists believe that testosterone replenishment may help reverse some of the key biochemical abnormalities that underlie metabolic syndrome, such as insulin resistance and central obesity.
Testosterone and the Prostate
A common misconception among physicians is that testosterone administration adversely affects the normal prostate. This idea is not supported by the medical literature. A 2002 study indicates that testosterone is actually beneficial for the prostate gland in the vast majority of cases. In this study, researchers looked at multiple parameters, including prostate volume, prostate-specific antigen (PSA) levels, and lower urinary tract symptoms in a group of men with low or low-normal testosterone levels. Of the 207 men studied, 187 responded favorably to testosterone treatment. These positive responders all showed improvement in almost every parameter measured: their prostate glands all decreased in size, PSA was lower, and urinary symptoms such as frequency, urgency, dribbling, and getting up at night to urinate all improved.
On the question of whether testosterone therapy causes prostate cancer, the answer clearly appears to be no. In a landmark review article published in 2004 in the New England Journal of Medicine, the authors report “there appears to be no compelling evidence at present to suggest that men with higher testosterone levels are at greater risk of prostate cancer or that treating men who have hypogonadism [low testosterone] with exogenous androgens increases this risk.” However, since testosterone stimulates cell growth, it is possible that it can accelerate the growth of an existing prostate cancer. Cancer-screening tests such as a PSA test are necessary before replacement therapy. Testosterone-replacement therapy is contraindicated in men with known prostate cancer.
Management of Low Testosterone Levels
Clinical studies have shown that testosterone replacement therapy in hypogonadal men improves metabolic syndrome indicators and cardiovascular risk factors. Maintaining testosterone concentrations in the normal range has been shown to contribute to bone health, lean muscle mass, and physical and sexual function, suggesting that testosterone replacement therapy may help to prevent frailty in older men.
Optimizing testosterone levels in men requires a multi-faceted approach that includes proper lifestyle, nutrition, nutritional supplements, dietary modifications, and exercise, as well as balancing other hormones even before testosterone supplementation.
Initially, a medical history and physical examination should be performed, along with a blood-testing panel that includes not only testosterone levels, but also other important parameters such as fasting glucose, PSA, estradiol, and complete blood counts (CBC). It is important to work closely with a knowledgeable physician who is readily accessible and who can adjust treatment as needed. Careful, thoughtful optimization of testosterone levels with a comprehensive evaluation and treatment plan can result in dramatic improvements in one’s overall health and well-being.
For men who no longer produce enough testosterone, an experienced doctor can prescribe either a topically applied cream or an injectable form of testosterone to restore to youthful ranges. In other instances another hormone maybe use to stimulates one’s man own testosterone production depending upon expected response in every individual. Follow-up blood testing 30-60 days later is important to ensure that hormone levels stay in normal ranges.
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