Men, Should You Be Taking Testosterone?

Julian Whitaker, MD

“Testosterone replacement has improved my confidence and outlook on life.” “I can’t believe how much more energy I have.” “The greatest difference I’ve noticed is my endurance. I’m a runner and cyclist, and since starting on testosterone, I can last longer and go further.” “In addition to feeling better, I look better—less belly fat and saggy pectoral muscles.” “I’ve got my ‘mojo’ back. My wife loves it!”

These are typical comments we hear from patients at Whitaker Wellness after starting on testosterone therapy. I can relate. I’m 67 years old and have been using supplemental testosterone myself off and on for several years. In a nutshell, testosterone replacement makes older men, myself included, feel and act younger.

Not Just About Sex

None of this should come as a surprise. Just as declining levels of estrogen usher in menopause, age-related reductions in testosterone are accompanied by changes in sexual desire and performance, mood, cognitive function, bone and muscle mass, and more. Hypogonadism or andropause, as it is referred to, affects virtually all older men to some degree, yet it is treated in only a very small minority.

This oversight has always perplexed me. I suspect that it’s partially because symptoms of testosterone deficiency come on gradually and are simply chalked up to aging. There’s also the close association between this hormone and sex, and men are notoriously reluctant to discuss diminishing sexual prowess. When they do, doctors usually prescribe Viagra or Cialis. Although these drugs are very effective at improving erectile function, only testosterone fuels libido. It’s the combination of the two therapies that really shift sexual drive and performance into high gear.

Yet few physicians routinely measure testosterone levels in their older male patients, even when they exhibit sexual or other symptoms of andropause, such as osteoporosis, sarcopenia (age-related muscle loss), weight gain, depression, cognitive dysfunction, and fatigue. And they completely ignore the extensive research on testosterone and metabolic syndrome.

Testosterone and Metabolic Syndrome

Metabolic syndrome, as you probably know, is a very common cluster of risk factors that dramatically increases risk of diabetes and heart disease. You may not know, however, that testosterone deficiency and metabolic syndrome go hand in hand. A low testosterone level leads to loss of muscle mass and weight gain; abdominal obesity in turn contributes to insulin resistance and is a cardinal sign of metabolic syndrome.

It’s a vicious cycle. Both obesity and insulin resistance inhibit the production of testosterone in the testes. Furthermore, testosterone is converted into estradiol (estrogen) in fat cells—another reason why obesity/metabolic syndrome reduce testosterone levels. The fallout is considerable. Studies suggest that a third of men with type 2 diabetes (even men as young as age 35) have suboptimal levels of this critical hormone, and diabetic men with low testosterone have a higher risk of death.

Testosterone deficiency also affects heart disease outcomes. Last year, an Italian research team reviewed all the scientific studies on testosterone and heart disease dating back to 1969 and found that lower levels of testosterone (and higher levels of estradiol) are linked with increased risk of cardiovascular disease and mortality.

Fortunately, this cycle can be broken with testosterone replacement therapy. In a 2011 study, researchers evaluated testosterone levels and metabolic parameters in 849 “hypogonadal” men and treated them with testosterone for a year. As expected, lower average levels of testosterone were noted in the men with metabolic syndrome at the study’s onset. But after 12 months of testosterone treatment, they had significant decreases in waist circumference, fasting blood sugar, and blood pressure.

Effective AND Safe

Many people, including physicians, believe that supplemental testosterone causes prostate cancer. After all, a leading treatment for prostate cancer is androgen deprivation therapy, or dramatic suppression of testosterone with drugs. Although men with prostate cancer should not be on testosterone, the idea that it causes cancer is simply not true—and an increasing number of experts agree that it’s time to put this myth to rest.

One of them is Abraham Morgentaler, MD, associate clinical professor at Harvard Medical School. In a recent paper, Dr. Morgentaler states, “With increased recognition of the benefits of testosterone (T) therapy for middle-aged men, there has been a concomitant reexamination of the historical fear that raising T will result in more prostate cancer (PCa)…. Modern studies indicate no increased risk of PCa among men with serum T in the therapeutic range.”

Natural Therapies?

If you’re still reluctant to use prescription hormones, your next best option for boosting testosterone is weight loss, followed by avoidance of excess alcohol, regular exercise, and adequate sleep.

DHEA, a natural hormone precursor to testosterone, causes mild but measurable increases in testosterone, and zinc, magnesium, and vitamin D are also helpful. “Aphrodisiac” herbs may have some effect on testosterone, but it’s highly unlikely that they could raise levels into the therapeutic ranges.

Bottom line, the most reliable method for improving your testosterone level is prescription hormone replacement. Discuss this with your doctor, and if he’s reluctant to consider testosterone therapy, find one who will.

Recommendations

• Have your blood levels of testosterone (total and free, the active and most important form) and estradiol tested. The “normal” range for older men is not the optimal range. At Whitaker Wellness, we aim for a blood level within the healthy young adult range.
• The preferable forms of supplemental testosterone are injections and topicals. (Most men, for obvious reasons, prefer topicals.) Patches, Androgel, and other commercial products are acceptable, but at Whitaker Wellness we generally use testosterone creams made by a compounding pharmacy. If your estradiol level is high, consider taking an aromatase inhibitor such as Arimidex (a prescription drug), Chrysin, or Myomin.
• To schedule an appointment with a Whitaker Wellness physician, call (866) 944-8253.
• Suggested average daily doses of recommended supplements are: DHEA 50 mg, zinc 60 mg, magnesium 500 mg, and vitamin D3 5,000 IU. I also suggest that men using testosterone take 320 mg of saw palmetto daily. Look for these supplements in health food stores, online, or order by calling (800) 810-6655.

References

• Bhattacharya R, et al. Effect of 12 months of testosterone replacement therapy on metabolic syndrome components in hypogonadal men: data from the Testim Registry in the US (TRiUS). BMC Endocr Disord. 2011;11(1):18.
• Corona G, et al. Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. Eur J Endocrinol. 2011 Nov;165(5):687–701.
• Morgentaler A. Testosterone and prostate cancer: what are the risks for middle-aged men? Urol Clin North Am. 2011 May;38(2):119–124.

Modified from Health & Healing with permission from Healthy Directions, LLC. Photocopying, reproduction, or quotation strictly prohibited without written permission from the publisher. To subscribe to Health & Healing, click here.