Fatigue, low libido, increased belly fat…these are complaints I hear almost every day in the office. Although very non-specific, one of the many potential causes of these symptoms is low testosterone.
Testosterone therapy had historically been used to treat male hypogonadism (low testosterone), most often due to either an issue with the brain signaling to make testosterone, or with decreased production of the hormone. However, when Big Pharma started mass-marketing testosterone replacement to the average Joe with low energy and low libido, all of a sudden there was an exponential increase in testosterone prescriptions. No doubt that most providers did their due diligence with properly screening for true low testosterone, however the massive increase in prescriptions alarmed the medical field that perhaps inappropriate prescribing was taking place.
Then, two studies, both later scrutinized for being critically flawed, were published concluding an increased cardiovascular risk with testosterone therapy. With these two studies, in addition to the known increased risk of cardiovascular disease when using anabolic steroids in those with normal testosterone levels, the safety of testosterone therapy quickly became hotly debated. In 2015, the FDA issued a Black Box warning for testosterone prescriptions, requiring manufactures to warn of potential increased risk of heart attack and stroke. And just like that, many providers became testosterone prescription adverse, denying many men the proper workup and treatment their symptoms deserved.
In that same year, an international expert consensus conference regarding testosterone deficiency and its treatment was held in an attempt to clarify the accepted scientific evidence regarding the relationship between testosterone and cardiovascular health. This conference produced 9 “resolutions”, which were conclusions that had received unanimous approval. Interestingly, one of those resolutions was a statement concluding the inverse relationship of testosterone levels with atherosclerosis, diabetes, obesity, CAD, and death.
Thankfully, societies like the American Urological Association and The Endocrine Society have since issued statements and treatment algorithms supporting testosterone therapy for people who have been properly screened and diagnosed. These algorithms are extremely helpful for primary care providers (like myself) who want to provide appropriate testosterone therapy.
It’s suspected that approximately 40% of men over the age of 45 suffer from low testosterone, with higher prevalence in those with type 2 diabetes and obesity. Some of the benefits of testosterone replacement include:
- Improved libido.
- Improved muscle strength and fat-free mass.
- Improved exercise capacity.
- Increased bone density.
- Improved insulin resistance.
Thus, if you or someone you know is experiencing the symptoms of low testosterone, I encourage you to seek out a provider who is comfortable diagnosing and treating low testosterone.
Lastly, I want to stress that hormone replacement is not the only way to treat low testosterone. There are several lifestyle modifications you can make to help boost your testosterone level naturally.
Lifestyle Treatments include:
- Weight loss (associated with decrease prevalence of low testosterone).
- Weight training (associated with increase in free testosterone).
- Aerobic activity (associated with improved sexual function, testosterone, weight, and fat mass).
- Treat Obstructive Sleep Apnea.
- Vitamin D: Increases total and free testosterone in those who are deficient.
Stay tuned for my next blog on female hormone replacement!