Should you take testosterone?

The pharmaceutical industry is marketing testosterone big time. You can’t watch an hour of TV or open a magazine without seeing an ad suggesting you might have “low T” and should ask your doctor about testosterone supplementation. Probably the only more prevalent ads are the ones about ED (erectile dysfunction) which push Viagra, Levitra and Cialis. The target audience is pretty much the same: us, the Second Sixtiers. Here’s what you should know:

Men with testosterone deficiency are often under-diagnosed and undertreated. The first signs of decline in testosterone are generally vague:

· diminished energy levels

· increase in irritability

· decline in mood

· decline in cognitive performance

· loss of early morning erections

While decreased libido and erectile quality are often the most frequent findings associated with falling testosterone levels, they are actually some of the latest symptoms.

Age-related drop in testosterone is associated with identifiable signs or symptoms:

· decline in muscle mass and strength

· decrease of bone mass

· increase in body fat, particularly abdominal and pectoral fat

· coronary artery disease and cholesterol derangement

· decline in cognitive skills or concentration and memory

· decline in stamina and exertion performance

· increased frequency of erectile dysfunction

· decline in sex drive and frequency of sexual thoughts

· decreased sense of overall well-being, perception of energy level and vigor

Low T affects much more than a man’s sex life. It increases the risk of just about everything that kills old people. The effect on mood and motivation make it harder to get up and do something about improving one’s health as well. We all know we can’t stay fit and healthy without proper diet and exercise, but when the motivation to exercise and eat well isn’t there, it just doesn’t get done. Even when it does, our bodies don’t respond like they did when we were younger.

So, if giving an older man testosterone will lower the risk of the main diseases and make him happier in the process, why is there resistance to T supplementation?

There are some dangers, though small and manageable, especially when compared with the benefits. Testosterone can raise the hematocrit and theoretically make one more susceptible to thrombosis, heart attacks and strokes. You should get T therapy only from a doctor trained in hormone supplementation.

There is also the association with steroid abuse by athletes. But we are talking about restoring T to normal levels. That involves something like 100 mg per week. Athletes will dope with 1000 mg a day! In addition, they will often combine T with growth hormone and other anabolics. Quite a difference.

Giving testosterone over time will shut down the testes, which is reversible. If you want to father children and keep your balls big, saggy and tender, you should choose another option besides testosterone injections. (BTW, saggy old-man’s balls happen because the testes slow down their production of testosterone, which triggers a response from the pituitary to grow bigger and produce more. Personally, I like the convenience of compact, pain-free balls.)

The big objection to testosterone supplementation, however, is that it increases the risk of prostate cancer. In the 1940s Charles Huggins presented his landmark work showing that castration caused the regression of metastatic prostate cancer and chemical or surgical castration has been a mainstay of treatment for prostate cancer ever since. Controversies and confusion have persisted, but after many years of testosterone usage, there remains no compelling evidence that testosterone replacement therapy does indeed represent a true risk for prostate cancer growth.

Although the normal prostate is androgen dependent, this does not mean that progressively higher testosterone levels will result in a greater prostatic growth. The testosterone receptor cells in the prostate are fully saturated at a level of approximately 90 ng/dl of testosterone, and beyond this level further addition of testosterone will not stimulate further prostatic growth, benign or malignant. (Normal levels are more like 300 – 1000 ng/dl.)

In a 2004 review of patients taking testosterone replacement therapy, the cancer detection rate was found to be 1% over a period of approximately 36 months. This cancer detection rate was virtually identical to the cancer detection rate in men undergoing routine prostate screening that were not on testosterone. Indeed, the men with higher testosterone levels were shown to have a lower risk of developing prostate cancer! On one hand, a low testosterone does not seem to protect against prostate cancer, and there is evidence that low testosterone is associated with higher grade cancers and a higher stage of disease at initial diagnosis.

So I favor testosterone supplementation to achieve levels normal for a healthy 30-year-old in all but patients with Stage 4 metastatic prostate cancer. I think testosterone diminishes the risk of disease, including prostate cancer, while enhancing health, wellness, mood, energy, passion and enjoyment of life.