Testosterone

More Than Just A Number

Aug. 13, 2015

Aging gracefully doesn’t have to mean accepting a steady decline. Today, men have ways of fighting back, especially when it comes to testosterone, the hormone with a profound effect on quality of life. Many people correctly associate testosterone with sexual health; low testosterone – or "Low-T," as it’s often called – is directly linked to erectile dysfunction, lower sex drive and low sperm count, but there’s much more to the story.

Testosterone is a naturally-occurring steroid that can affect underlying health factors such as mood, bone density, muscle mass and overall energy, causing it to play a central role in overall well being. Yet, health care providers report that many men – even those showing symptoms of Low-T – never get a diagnosis or treatment, although a wide variety of treatment options exist.

Some do get help. A local testosterone patient in his late 60s, on condition of anonymity, put it this way. "I finally went to a urologist. It’s changed my life. I went through years of feeling increasingly tired. I was depressed about it. I finally understood that testosterone drops as you age and some men are affected by this more than others."

WHY NOT SEEK HELP?

Some men avoid seeing a doctor because they have concerns that testing and treatment might not be covered by insurance. For some men, it’s because of misplaced male pride; they feel embarrassed because they think Low-T is a sign of inadequacy.

Regardless of their reasons, the reality is that testosterone production begins to decrease in most men around age 30, a trend that generally continues throughout life. Dr. John Faichney, FACP of Endocrinology Consultants in Traverse City confirms that low testosterone is not a personal failing and, in most cases, is a treatable condition.

"It’s just not correct to see this gradual testosterone decline as a disease process. Women have menopause, but it’s considered part of the life cycle," Faichney said.

Low-T is easy to identify. Men experiencing fatigue, decreased libido, loss of muscle and bone mass, increased fat, mood swings – some of the classic symptoms of decreased testosterone – can get a simple blood test (or series of tests) to learn where they land on the testosterone spectrum. Normal blood level testosterone generally falls in the range of 300–1,000 ng/dL (nanograms per deciliter).

WHAT CAN BE DONE?

Some men avoid getting help because they believe that, if they have Low-T, nothing can be done about it. Fortunately, they’re wrong. There are at least five types of medical treatments that boost testosterone levels. They include injections, skin gels, lozenges, nose sprays and pellets implanted under the skin. Each method has its strengths and weaknesses. Some last for 10 weeks and some for up to three months, while others begin losing their impact much more quickly.

Dr. Phillip Wise, a board-certified Michigan urologist with 30 years experience, says some long-used methods – injections every two weeks, for instance – have a downside. They "can result in many peaks and lows in [testosterone] levels."

Wise says some newer therapies promise fewer fluctuations and some also last longer and are more convenient to administer. However, at this point, all treatment options share one important trait: they only temporarily replace testosterone. They do not stimulate your body to produce more on its own.

"So, eventually, you’ll need a refill," said Wise. "It can be compared to filling your car with gasoline. You run out."

IS THIS THE ANSWER?

Testosterone replacement isn’t a decision to take lightly. You may know your testosterone level, but that’s simply a starting point.

"It’s a whole lot more complicated than what testosterone manufacturing companies want you to believe," said Wise.

Contrary to marketing myths, more doesn’t necessarily mean better when it comes to hormone replacement of any type, Dr. Faichney explained. Not everyone needs the same amount of testosterone. Below 300 ng/dL might be the point at which therapy becomes an option for most men, but it’s not the case for all men.

"Dose targets should be adjusted according to the needs of the individual," said Faichney.

There’s also the issue of determining and, if possible, dealing with the causes of Low-T. Aging may be the main culprit, but many other physical and mental health issues can contribute – sometimes significantly – to Low-T, which means those who jump into hormone replacement without a thorough diagnosis may be only treating a symptom, not the cause of the problem.

Complicating matters even more is the fact that some medical conditions – depression, for example – might be both a symptom and a cause. Depression is generally thought to be one of the causes of Low-T, but, as with the patient mentioned earlier, Low-T can also contribute to depression.

Controversy about potential replacement therapy side effects is another issue. Some physicians and researchers believe replacement therapy can elevate red blood cells, cause sleep apnea and stimulate prostate growth. Others think it might contribute to prostate cancer.

Wise is skeptical of this, especially when the dosage is appropriate. "If we’re just getting a patient back into the normal range, I don’t think we need to be too concerned about added prostate cancer risk."

Faichney cites concerns about blood vessels and the possibility of increased risk for heart problems as "legitimate concerns." He emphasizes the need to identify and treat the cause, or causes, of testosterone suppression.

"A thorough history, and physical and additional testing, such as for pituitary function, is indicated in persons who have unequivocal testosterone deficiency," he said.

Wise relies on an exhaustive, 12-point protocol before recommending therapy, while Faichney thinks a patient’s testosterone levels "should be consistently below the normal range in the morning on two or three separate occasions," before considering replacement therapy.

Even when taking these precautions, questions can still linger, especially "if the patient is sick, has chronic pain, suffers from depression or feels stressed out. That’s because any of these conditions may be the actual source – and not a symptom – of low testosterone," said Faichney.

Even when testosterone therapy is clearly the correct course of treatment, there is general agreement that it should be used sparingly.

"From where I sit, I see downsides to therapy for people who don’t really need it, or so much of it," said Faichney. "There are folks who don’t get a good diagnosis, then become dependent upon it. It’s easy to write a prescription, but you want to make sure you’re on firm ground."

HOW TO HELP YOURSELF

There are steps men can take on their own to promote better testosterone health. Some of the self-help suggestions cited include limiting alcohol consumption, getting high quality sleep, shedding excess weight, lifting weights, exercising in short and intense spurts, managing or avoiding stress, reducing sugar intake and, in some cases, increasing consumption of zinc. Of these behaviors, Wise believes shedding excess weight can have the greatest impact.

GOOD NEWS

There’s plenty of good news these days for men who suspect they might have Low-T. A simple blood test (or series of tests) can determine testosterone deficiency and, in most cases, Low-T can be treated. Still, there are challenges for patient and doctor alike.

Wise and Faichney say treatment must be based on individual factors and not just a blood test number. Also, there can be numerous causes for the condition beyond aging.

Even when therapy is deemed medically appropriate, there remains considerable debate over possible long-term effects.

Yet, when it succeeds, testosterone replacement therapy can help restore overall energy and libido, aid in fighting depression, and help a patient embrace life more fully.