Bartecchi: Testosterone and men
According to recent Mayo Clinic information, testosterone (t) helps maintain bone density, muscle mass, red blood cell production and sexual function. In men with hypogonadism, (t) replacement can improve libido, bone density and muscle mass. Signs and symptoms of hypogonadism along with (t) tests showing a low (t) level will help your physician determine whether you have hypogonadism.
According to the U. of Rochester Medical Center, most (t) in the blood is attached to protein, but 2-5% is free (t), not attached to protein. Total (t) is usually checked first. The free (t) can help give more information when total (t) is low. Free (t) is most useful when it is suspected that the sex-hormone binding protein is abnormally decreased, leading to a potentially falsely low (t) reading.
Low (t) levels can be due to age or medical conditions that affect the testicles, pituitary gland or brain, as well as a number of important factors that need to be considered. Testosterone levels are highest in the morning and lowest at night. Too much exercise, poor nutrition, illnesses and medications can lower the (t) in the body. In a recent Forbes magazine article, experts noted that opioids as well as abusing steroids can lower (t) levels. Diabetes, obesity, heavy alcohol consumption, and stress related increase in cortisol levels can also lower (t) levels.
According to the Endocrine Society, (t) levels naturally decrease by 1% each year after age 30. A USC Medical School study noted that men in their 70s have mean (t) levels 35% lower than younger men. Testosterone levels must be measured in the morning by an approved lab, more than once, in order to be accurate.
Testosterone replacement therapy is recommended only for proven hypogonadism patients. For reasons mentioned earlier, a low (t) level, by itself, does not need treatment. The FDA does not approve of boosting (t) levels to help improve strength, athletic performance, physical appearance or to treat, prevent or slow the problems associated with aging because of potential side effects of (t).
Sales of “(t) boosters” are promoted on TV, magazines, and newspapers, which often feature retired, aging, pro athletes and body builders. You will recognize these products by their potent sounding names (Eg. Nugenix Total T Ultimate Accelerator). According to the journal Androgens, the internet is the main source for the purchase of these often expensive products, with yearly sales in the millions of dollars. A USC Medical School study showed that 90% of the “(t) booster” supplements claimed to boost (t), though only 25% had data to support their claims. Another 10% were found to have a negative effect on (t) levels.
The FDA, in fact, claims that there is no robust evidence that (t) boosters are effective. Commercially sold (t) boosters are nearly always comprised of multiple supplements (vitamins, minerals, herbs, etc.) none of which have undergone rigorous evaluations.
According to Forbes magazine, (t) boosters typically contain a variety of vitamins, minerals such as zinc and magnesium and herbs such as fenugreek, different ginsings, yohimbe, ginger, horny goat weed, etc. Though some studies have suggested possible increases in blood (t) levels, the data is inconsistent and studies differ widely in methods and dosages. Serious adverse events, such as liver damage, have been reported with these ingredients and the existing literature fails to suggest the use or value of these products.
Dr. Desai, mentioned in the Forbes article, says “I can’t say that that I’d recommend any supplements.” Dr Honig, from Yale Medical School warns against taking (t) boosters that claim that they can boost (t) levels, noting that there is no regulation of these supplements by the FDA and no proof that they actually work. Also, they can be dangerous because you don’t know what exactly is in them and how they may impact the body or interact with other medications a patient is taking or what impurities they may contain. Excessive amounts of vitamins, minerals or herbs in supplements can also be a problem.
According to the Mayo Clinic, some (t) therapy risks include sleep disorders, acne, and other skin problems, stimulation of noncancerous growth of the prostate gland and growth of existing prostate cancer. Fortunately, a recent New England Journal article noted that (t) replacement therapy used to treat hypogonadism didn’t appear to increase the risk of serious heart problems as some experts had feared, though an accompanying editorial suggested that there were questions raised about several aspects of that study.
In any case, the findings do not justify the more widespread use of (t). According to the Forbes article specialists, (t) can be increased naturally by weight loss if the subject is obese, eating a heart healthy diet, minimizing alcohol consumption and exercise. However, weight lifting can increase (t) levels but the levels stay elevated for only a few hours.
Should there be any questions about (t) supplements, boosters, hypogonadism or related, important lab studies, one should check with an internist/endocrinologist or a urologist.
Dr. Carl E. Bartecchi, MD, is a Pueblo physician and clinical professor of medicine at the University of Colorado School of Medicine.
This article originally appeared on The Pueblo Chieftain: Bartecchi: Testosterone and men
