Testosterone: Magic Bullet — or Pharmaceutical Hard Sell?
Testosterone is being touted as the next new health cure for men, with claims it will boost libido, build muscle mass, ease depression, slow cognitive decline, and even increase lifespan. A study from the National Institutes of Health found a marked lower risk of death in men with low testosterone taking the hormone compared to men with low testosterone who were not taking the hormone.
New testosterone products are hitting the market, but some experts warn that the evidence is not yet there to embrace their widespread use in millions of older men who experience low testosterone levels, or “low T” – also referred to as “male menopause.” Rather, it is a part of normal aging that can be addressed in other ways.
Testosterone is a steroid with potentially serious side effects, including an increased risk of prostate cancer. (See side effects, below.) Some research indicates there may be a link between testosterone use and heart disease as well.
Low T ‘Caused by Signaling Disorder’
Product literature for AndroGel, a testosterone product rubbed on the skin, states that 15 million American men have low T, and that it is “caused by a signaling problem that occurs between the brain and the testes that causes the production of testosterone to drop below normal.”
Really? Millions of men have a condition called low T? Is this truly a disorder that requires drug treatment? Or are drug companies pandering to men’s fear of growing older?
There is no doubt that drug companies are guilty of “disease mongering” with new medications aimed at a wide audience, according to a report from the NIH:
“Pharmaceutical companies research, develop and exploit drugs to prevent, control and cure diseases and treat symptoms. Companies then market these medications to recoup their investments and reward shareholders. It would seem to serve the interests of society, but some critics characterize it as a vicious circle in which businesses invent new diseases to match their existing drugs.”
Testosterone Levels Naturally Decline
It is true that after age 30, a man’s testosterone levels naturally decline by about 1% a year. By the time a man is 70, his testosterone level can be lowered by as much as half.
This can cause:
- Fatigue or decreased energy
- Reduced sex drive (libido)
- Sexual dysfunction (weak erections, fewer erections)
- Depressed mood
- Increased body fat
- Reduced muscle mass and strength
- Decreased bone strength
- Hot flashes, sweats
Now, new testosterone products, such as skin gels and creams applied to the armpit, are aimed directly at low T in aging men (usually those over age 50). An oral treatment, implantable pellet, injection, patches, and form of testosterone absorbed through the gums are also available.
T Levels, Symptoms Determine Therapy
How is “low T” determined? Drug companies define it as having symptoms as well as blood testosterone levels of below 300 ng/dL. (A normal blood testosterone level is 300 -1,000 ng/dL.) But there is no consensus about when men should receive treatment.
Some guidelines advocate giving testosterone to men with symptoms of low T, but who have low-normal testosterone blood levels above the 300 ng/dL cutoff. One review advocates giving testosterone to any “aging male” with symptoms of low T and a testosterone level below 300 ng/dL “under most circumstances.”
Alternately, some endocrinologists advocate not giving testosterone unless blood testosterone levels are 200 ng/dL or less, particularly in men over 65, who are more prone to prostate problems and other side effects of testosterone. The Endocrine Society is cautious, and recommends that testosterone be used “judiciously”, and that “more data are needed to determine which patients will benefit from treatment and for which symptoms”.
Side Effects May Occur
Testosterone can have serious side effects. It may cause polycythemia, a potentially life-threatening condition that causes the body to produce too many red blood cells. Other side effects include:
- Possible stimulation of the prostate, leading to benign prostatic hyperplasia (noncancerous enlargement) or enlargement of existing prostate cancer (experts suggest men undergo prostate screening before starting testosterone)
- Breast enlargement
- Sperm production decrease
- Shrinking of the testicles
- Sleep apnea
- Possible increased risk of heart disease (in older men)
For these reasons, broad use of testosterone therapy for treating symptoms of normal aging in men is “not currently advisable.” If it is taken, testosterone is not meant to be used indefinitely, and testosterone levels should be routinely monitored to make sure blood levels are within normal limits.
If you do decide to try testosterone therapy, weigh the pros and cons with your doctor, and don’t expect the medication to be a panacea for improving your overall health. You should still exercise regularly, eat a well-balanced diet, get enough sleep, limit alcohol intake, and quit smoking – no matter what your age.