The Low Down on Low-T; Replacement Can Help


Male swagger and bulging muscles, the stereotypical image of too much testosterone, may be booted out the locker-room door as specialists look at the hormone in a new light.

Specialists are increasingly viewing testosterone as much medical as it is machismo, and critical to mens health. In fact, particularly as men age, low testosterone (Low-T) can be a problem, which testosterone replacement therapy (T-replacement therapy) can easily cure.

Yes, some symptoms of Low-T, like diminished libido, are sexual. But experts say theres much more to the story. If youre 40 and above and experiencing a constellation of symptoms like low energy, irritability, malaise, poor cognition, or even reduced work performance, tell your doctor to test you for Low-T.

Underscore tell. The test for Low-T requires patients to fast and has to be done first thing in the morning, and is not routine in the annual male physical.

The test just isnt yet on the primary care physicians radar, says Dr. Marina Johnson, an endocrinologist and author of Outliving Your Ovaries. When older men come in complaining about sexual function, doctors tend to accept the condition as a consequence of declining age.

But that doesnt have to be the case--some men are virile into their 80s, according to Johnson. Worse still, a physician hands over a script for Viagra or Cialis.  Its not a solution but a quick fix  while other issues are left untended.

On the other hand, some physicians are uncomfortable talking to their patients about sex, according to Dr. Abraham Morgentaler, a Harvard MD and urologist and author of Testosterone for Life. That is one reason why Low-T is terribly diagnosed and undertreated.

The other issues of Low-T are often referred to as nonspecific, but Morgentaler argues that simply isnt true. The idea of men aging and having treatable symptoms is not widely taught in medical schools or accepted in all medical practices.

This notion is both unfortunate and unhealthy, considering the onslaught of Baby Boomers in their 40s and 50s who are vulnerable to Low-T.

Studies that follow groups of men over a five, 10 and 15-year period have shown that men with the lowest testosterone level doubled their risk of diabetes, and had a 2.5-3X higher risk of osteoporosis.

Testosterone is as important to mens bones as estrogen is for women, says Morgentaler. Men with lower testosterone die sooner than men with normal levels of testosterone.

Making Testing Standard 

The high stakes surrounding Low-T makes testing routine in Johnson and Morgentalers practices.

Morgentaler prefers a free testosterone blood test that looks at the carrier molecule to which testosterone is bound in the body. In borderline cases, this test more accurately reflects Low-T than a total testosterone test which some physicians also administer. A normal level is 300 nanograms per deciliter (300ng/dL).

A thorough evaluation doesnt stop with the blood. Johnson emphasizes a thorough patient history; a patient may suffer from sleep apnea, which is a common cause of Low-T.

Johnson also says medications related to other conditions can lead to Low-T. High doses of cholesterol medications can be culprits. Cholesterol is a building block for hormones and a 100 mg/dL to  110 mg/dL total cholesterol level prevents these building blocks from doing their work. In such cases, cutting back on statins may reverse Low-T without any other intervention.

Johnson says it is also important to rule out more serious conditions. A tumor on the pituitary causes an overproduction of prolactin which in turn suppresses the production of testosterone.

Morgentaler says he initially measures a patients muscle-to-fat body composition. Three to six months into T-replacement therapy, the measurement is repeated with some good results: a gain of two pounds of muscle and a loss of two pounds of fat.

Testosterone for Prostate Cancer

For men suffering with prostate cancer, a recent small study pokes some holes in the long-time physician thinking that men with prostate cancer should not be given the hormone because administering testosterone to a prostate cancer patient is like pouring gas on a fire, says Morgentaler, the studys lead author.

In that study, researchers studied 13 men with scores of six or seven on the 10-point Gleason scale, indicating mildly to moderately aggressive prostate cancer. The men chose not to be treated, and agreed to testosterone therapy with active physician surveillance for two and a half years. In the follow up, none showed progression of the cancer or a spread to other organs.

In fact, 54% showed no cancer at all, says Morgentaler.

T-Replacement Benefits and Risks

Replacement of testosterone can be administered through injections, orally, skin patches or a gel, the latter which is increasingly preferred because you achieve a more physiological delivery, according to Johnson. She recommends bio-identical hormone replacement over synthetic. The idea is to restore a product identical to what the body is missing."

If you go on T-replacement therapy, you are pretty much on it for life.

Risk factors like mild acne, breast tenderness and foot and ankle swelling can occur but often subside. Some men experience a rise in hematocrit and have blood tests one or two times a year to monitor this condition. If individually bothersome, any of these conditions can be corrected by discontinuing the therapy.

T-replacement is not a fountain of youth and not a panacea, but it is quite safe says Morgentaler, who believes that 5% of whom a man is depends on a normal or abnormal T-level. T-therapy can return a Low-T sufferer into a man who is healthy, vital and glad to be alive.