Low Testosterone Controversy
Two strongly contrasting views are emerging concerning the question why:
- men from midlife onwards experience low testosterone levels
- and whether treatment to supplement low testosterone is good for health
The controversy revolves around whether low testosterone is:
- An inevitable part of aging
- Or caused by chronic disease and poor health choices – like smoking, obesity and depression – and not inevitable
Those who claim low testosterone is not an inevitable part of ageing, but is caused by chronic ill health, also then say testosterone therapy to combat ageing is wrong because it does not address the underlying problem.
An Australian study could be influential in changing views on how low testosterone occurs and how it affects men’s health.
Low Testosterone ‘Not Inevitable’
It has been generally accepted that from the age of 40 to 50, male testosterone levels began to drop by up to 1 per cent a year, and there is little men can do to stop it.
But analysis of blood samples from 1500 men in a study supported by the National Health and Medical Research Council of Australia, showed “declining testosterone levels are not an inevitable part of the aging process, as many people think,” says study co-author Gary Wittert, MD, professor of medicine at the University of Adelaide.
“Testosterone changes are largely explained by smoking behavior and changes in health status, particularly obesity and depression,” says Dr Wittert.
Sydney Low Testosterone Trials
That view is shared by Sydney’s ANZAC Research Institute director David Handelsman, the lead author of one of the Australian testosterone studies. He believes testosterone is being over-prescribed to Australian men as an anti-ageing treatment when his research shows low testosterone is not related to ageing.
But a major testosterone replacement therapy clinical trial being conducted at Sydney’s Prince Henry Hospital indicates this view may be over-simplifying a complex condition.
Preliminary data already published from the trial suggests that testosterone replacement therapy (TRT) causes modest reductions in body fat, particularly abdominal fat, which may have benefits in reducing the risk of cardiovascular disease, through changes in several “risk markers including:
- Cholesterol levels
- Insulin resistance
- Blood clotting factors
This helps reduce risk for heart disease and diabetes and other chronic health problems.
Testosterone Use in Australia
Testosterone treatment levels vary in Australia, with the highest use of testosterone therapy in Queensland and the lowest in Tasmania. Dr Handelsman suggests some doctors are promoting testosterone replacement therapy for commercial rather than health reasons.
He says testosterone use rose steeply after 2006 when two new products, a gel and a slow-release injection, came on the market.
The gel is a more appealing alternative to traditional injections, patches, and oral medications that were previously the only way to correct testosterone deficiency. Patches can cause skin irritation and oral medications can cause liver damage.
Benefits of Low Testosterone Treatment
Advocates of therapy to supplement low testosterone levels see testosterone as an important alternative treatment for erectile dysfunction and as a key to improving symptoms of low testosterone like fatigue and depression as well as helping with weight loss and reversing pre-diabetic metabolic syndrome.
Typical of those who support testosterone supplementation is Dr Eugene Shipper who says: “When testosterone is normally abundant, it is at the core of energy, strength, stamina and sexuality. When testosterone is deficient, it is at the core of disease and early demise.” (The Testosterone Syndrome, 2007)
They argue there is good evidence bringing low testosterone levels back to normal has benefits in improving erectile dysfunction and sex drive as well as in reducing weight and risk of chronic disease – diabetes and cardiovascular disease in particular.
(The opposite is also true: losing weight naturally can increase testosterone levels by 50 per cent.)
Low Testosterone and Erectile Dysfunction
Men who turn to erectile dysfunction drugs without getting their testosterone levels checked may be limiting their options, according to Houston urologist Dr Larry Lipshultz.
“The drugs now available to treat erectile dysfunction all work better when a man’s testosterone is normalized because they depend on a biochemical system in the body that is testosterone-dependent,” said Dr Lipshultz, a professor of urology at Baylor College of Medicine.
The more testosterone you have, the greater chance erectile dysfunction therapy will enhance erection and treat erectile dysfunction.
He says urologists have seen success in the combined use of erectile dysfunction drugs with testosterone replacement therapy in some patients.
“Some patients take testosterone and then no longer need their erectile dysfunction drugs.”
Symptoms of Low Testosterone
Men with low testosterone levels are typically over 40 and have symptoms common to many conditions including:
- Mild lapses in cognitive function
- Low sex drive
- Problems losing weight
Because of the similarity of symptoms, low testosterone is often misdiagnosed as depression, says Dr Lipshultz.
“Unfortunately, a large number of men are being put on antidepressants who really need to have their testosterone checked because men’s testosterone does decrease with aging,” says Dr Lipshultz.
“Androgen deficiency is something that we now know does exist, can be measured, and is easily treatable.”
A greater awareness of “andropause” or ADAM (Androgen Deficiency of the Aging Male) would result in more accurate diagnoses, Dr Lipshultz says.
Signs of Low Testosterone
You might notice:
…you used to want sex every day but now you’re happy really to leave it to a couple of times a week
…however much you exercise you can’t seem to get rid of that spare tire around your middle
…you can’t seem to hit a golf ball as far as you used to
…you seem to have just lost your drive and motivation… your mojo…
Dr Abraham Morgentaler, a Harvard Medical School professor and an internationally recognised expert on sexual medicine, says low testosterone is a surprisingly common but undiagnosed condition amongst many middle aged men. Many men have signs of it, without experiencing full-blown symptoms.
In Testosterone for Life (McGraw Hill 2009), Dr Morgentaler summarises:
Top Five Sexual Symptoms of Low Testosterone
- Decreased desire – low sex drive
- Erectile dysfunction
- Difficulty achieving orgasm
- Reduced amount of ejaculatory fluid
- Reduce intensity of orgasm
Treatment for Low Testosterone
Testosterone treatments are available as injections, gels, patches or a gum pellet. Consult your health professional for the relevant tests.
There are dangers associated with testosterone treatment and testosterone replacement therapy should be monitored to ensure levels stay within safe limits. Australian research shows high levels of testosterone are linked to prostate cancer.