Been watching TV or listening to the radio lately? Odds are you've heard ads for low testosterone treatments. Is this a new disease or is awareness and treatment of this disease increasing? The answer is probably both. Low testosterone, or hypogonadism if you want to sound doctory, is a common condition in men as they age. It has been described since the late 1880s when the famed physician Brown-Sequard isolated animal testosterone and injected himself--the first reported use of performance enhancing drugs. These days, hypogonadism is all over the place because there are lots of companies manufacturing treatments for the condition and can market to mass audiences. And it's an easy sell because most men feel better when they initiate therapy. Low testosterone is also increasing because obesity, sedentary lifestyles, poor nutrition are all increasing in the world and are all associated with low testosterone.
How do you know if you or someone close to you has hypogonadism? Some signs are very specific--loss of sex drive, poor erections, loss of muscle mass, for example. Other signs are less concrete--loss of energy, depression, weight gain, moodiness, diminished intellect. Any of these signs should prompt a visit to a health care professional who can ask the appropriate questions, perform a physical exam, including a prostate exam in men over 40, and order the blood tests necessary to confirm the diagnosis.
Should every man with hypogonadism be treated? The answer is most men would benefit from therapy with improved libido, erections, mood, energy and other gains. The average weight loss after starting testosterone is 4 pounds of fat with a subsequent weight gain of 3-4 pounds of muscle--all good things. However, losing weight and vigorous exercise without testosterone therapy has been shown to improve a man's testosterone and reverse the symptoms of low testosterone. That should be compelling enough for most men to get off the couch but lack of motivation from low testosterone is a pretty powerful inertia to overcome. Men with a history of prostate cancer or untreated prostate cancer need to see a specialist in Men's Health that can discuss in great detail the risks and benefits of testosterone replacement in the prostate cancer patient. In my practice, I strongly encourage my men to adopt a healthy reduced calorie diet heavy in lean protein and start exercising 30 minutes a day and work their way up from there. If these men do go on testosterone therapy, I monitor their blood work, weight and nutrition closely to make sure they are optimizing their response.
The downside to testosterone therapy is pretty minimal. This is a form of hormone replacement and therefore affects multiple organ systems. Physicians treating low testosterone need to monitor a man's red blood cell count as treatment can increase red blood cells and thicken the blood too much. Testosterone replacement can also elevate a man's PSA, or prostate specific antigen test, which is a screening test for prostate cancer. Despite lots of misinformation out there, testosterone doesn't increase a man's risk of prostate cancer, but urologists need to monitor the PSA to continually evaluate a man's risk. The big complaint many men tell me after they've started therapy is they notice their testicles shrinking. Testosterone therapy reduces or completely turns off sperm production and therefore the testicles do shrink on therapy. This process is almost always reversible but men need to know this, especially if they're trying to initiate a pregnancy.
In the next segment, we'll go over treatment options for hypogonadism and try to make sense of the various advantages and disadvantages of all these options.