Open any men’s magazine or visit a website that targets men or men’s health and you probably will see them: ads promoting testosterone hormone therapy and articles urging men to consider taking testosterone to improve muscle mass, lose weight, improve their sex drive, and boost their mood. But is testosterone therapy the answer to these and other issues that commonly affect men as they approach and surpass their 50th year?
Marketing moguls and companies that will profit from selling their testosterone products want you to believe it can. After all, use of testosterone therapy promises to combat aging and some of the fears and anxieties that go along with it. Why wouldn’t men want to buy into that? The “fountain of youth” in a gel! Sex like a teenager!
I have a bunch of friends who are on T-therapy and none of them have been diagnosed with actual male hypogonadism (see below for the clinical definition of low-T). All of them except one (who takes it for cosmetic reasons) have been convinced that the symptoms they are experiencing as they age are due to low testosterone. I say the same thing to each of them – you need L-therapy not T-therapy.
What do I mean by this?
Whereas the medical community and testosterone clinics argue that your low-T is the reason for your decreased sex drive, loss of energy and other symptoms – the evidence, clinical trials and studies are clear that changing your “lifestyle” (hence my term “L-therapy”) has the greatest impact on the symptoms you are experiencing. In short, it’s not low-T that’s your problem – it’s a mix of other lifestyle factors that are contributing to your loss of energy, sex drive and vigor.
The good news, though, is that you can do something about it.
Before I get to this however, it helps to recap what testosterone therapy is.
What is testosterone therapy?
Testosterone therapy (or testosterone replacement therapy) is typically prescribed for men who have low testosterone levels and/or symptoms of low T and/or normal T levels but symptoms of low T. In most of these cases, testosterone therapy is not the appropriate treatment, as I discuss below. However, it is considered to be “the remedy” for the classic symptoms most often associated with men as they get older. (See “Classic Symptoms Leading to Testosterone Therapy”)
Experts generally agree that men’s testosterone levels naturally decline about 1 percent per year starting around age 30. However, there are two other factors to consider. One is the finding that “poor health may accelerate the age-related decline” in androgen [testosterone and other male hormone] levels.”
Another comes from results gathered from men who participated in the Healthy Man Study in Australia. David Handelsman, MD, PhD, director of the ANZAC Research Institute at the University of Sydney and his team studied 325 men, age 40 to 97, over a three-month period. They took nine blood samples during that time and measured testosterone levels.
Over the study period, T levels did not change in the men, leading Handelsman to say that “age alone does not make you testosterone deficient,” and that men who have a drop in T levels should talk to their doctor about underlying health conditions that could be contributing to the decline.
Testosterone therapy for men is available in five different forms.
- Patch. Two different types of patches are available: one that can be worn on the arm or upper body and applied once daily; or one that delivers the hormone through the membranes in the mouth via a patch applied twice daily to the upper gums.
- Gels. Two types of gels are available: one that is applied to the skin and another that is applied inside the nostrils.
- Injections: The hormone can be injected directly into the muscles. This is the type of therapy promoted by Cenegenics and most other low-T clinics. It can cost $1,000-$2,000 a month to be on one of these programs.
- Implants: Pellets of testosterone can be implanted in the soft tissues and the body can slowly absorb the hormone into the bloodstream.
- Pills: Although testosterone is available in oral form, it is not well absorbed and can damage the liver.
Note that testosterone therapy is not the same as supplements that can help with promoting free testosterone. T-therapy is the actual use of the hormone “testosterone” applied in one of the forms above. Natural supplements on the other hand do not contain testosterone but can help with the promotion of your own natural testosterone production.
What is a normal testosterone level?
This is a great question. Experts have been challenged to identify a “normal” testosterone level for men because there are many factors to consider. For example, fluctuations in daily rhythms, age, use of medication, presence of health conditions, and the levels of sex-hormone binding globulin (SHBG) all can have an impact on total T levels.
That said, health professionals (whoever they are) have established that the normal range of total testosterone in adult males is 240 to 900 ng/dL (nanograms per deciliter). That’s a pretty huge range if you ask me – and as I point out below, the actual number doesn’t really matter. A value of less than 200 ng/dL is considered to be hypogonadism, or true “testosterone deficiency”, in which the body is not naturally producing enough of the hormone. This can be the result of a problem with the testes (primary hypogonadism) or with the hypothalamus or pituitary gland (secondary hypogonadism). Both types of hypogonadism are typically treated with testosterone therapy, which is the only legitimate use of this treatment approach.
If you are considering testosterone therapy, be sure you ask your doctor to first check your testosterone levels. This is easily achieved using either a blood or saliva test. Hypogonadism is not that common, so chances are you fall into one of the six categories discussed below (“6 Reasons Men Should Not Take Testosterone Therapy”) and don’t need testosterone therapy. And get your levels checked in the morning when your T-levels are usually the highest. Some low-T clinics make a point of asking you to come in to get checked in the late afternoon when your T-levels are at their daily low. It’s a cheap trick that pretty much 100% of the time leads to you getting a prescription for your new addiction.
Side effects of testosterone therapy
It seems to me the side effects of testosterone therapy alone are reason enough to avoid this treatment strategy. One of the scariest adverse effects is an increased risk of heart attack. A recent study reported that within three months of taking testosterone therapy, men 65 and older as well as younger men who had heart disease had double the rate of heart attacks.
Also, unless you like the idea of becoming hooked on testosterone therapy, you definitely want to look at other options. Because that’s what can happen as the body stops making the hormone as it increasingly depends on the therapy. Other side effects of testosterone therapy can include increased risk for stroke, polycythemia (red blood cell volume elevation), sleep apnea, acne, and breast enlargement. Just watch and listen to the TV ads. The first 15 seconds are all builders, pilots and mechanics with 5 day facial hair doing man-shit. The other 3 minutes is all the side effects. Bodybuilders and other heavy t-users also have to book frequent trips to see a phlebotomist for blood transfusions – to prevent the heavy blood clotting that occurs due to the therapy.
Classic symptoms leading to testosterone therapy
The biggest complaints men have that often lead them to consider testosterone therapy are weight gain, lack of energy, low libido, depression, and lack of muscle tone. They have been convinced that taking testosterone therapy will solve their problems.
The makers and marketers of testosterone therapy hope you believe this myth. But the other side of the coin is more likely the truth: men have low T and/or these classic symptoms because they are overweight, don’t get enough sleep, eat a poor diet, consume too much alcohol, are sedentary, and don’t manage chronic stress.
In other words:
- These classic symptoms that drive men to think they need testosterone therapy are the result of lifestyle choices, not low testosterone.
- While it is true that testosterone levels decline somewhat with age, lifestyle changes and not testosterone therapy is the way to tackle the classic symptoms.
Using L-therapy not T-therapy
Men who fit any of the six reasons to avoid testosterone therapy (see below) should instead take a serious look at their lifestyle. The following lifestyle factors can have a massively positive effect on your testosterone levels. Take a look to see which ones you can change to help improve your testosterone levels and eliminate your symptoms?
- Healthy diet. Focus on a diet that is based on whole, natural foods and is low in sugar and unhealthy fats. A good example is the Mediterranean diet. In addition, some foods naturally help boost testosterone levels. Two of my friends mentioned above consistently feed themselves on a diet of highly refined and processed foods. Recently, one of them also got prostate cancer. Clean up your diet and you will feel the natural energy and sexual boost that follows.
- Regular specific exercise. A combination of intense aerobic and strength training (lifting heavy weights) can help boost T levels. Research shows that high intensity interval training (HIIT) can also boost T levels. One of my T-taking friends was constantly exhausted because he was doing a lot of endurance exercise that has been shown to increase the adrenal load and decrease T. He was exhausted because he was training to hard and too long without adequate rest and sleep. Since cutting back on the long runs and rides he has seen his energy increase and he’s sleeping better as well.
- Maintain a healthy weight. Men who carry excess fat also can have too much estrogen, since this hormone is produced in fat cells. An imbalance in estrogen and testosterone levels is a recipe for classic low-T symptoms. Lose the excess weight (diet and exercise will definitely help) and then maintain your new, healthy weight.
- Stress management. Stress can cause low T because the stress hormone, cortisol, blocks production of testosterone. Daily management of stress using meditation, yoga, tai chi, progressive relaxation, or whatever works for you, is highly recommended.
- Adequate sleep. Do you get at least 7 hours of sleep each night? If not, then your T levels can decline. Seven to 8 hours of sleep nightly is recommended to help maintain healthy testosterone levels.
- Limit alcohol. Drinking alcohol has two main effects on sex hormones: it lowers testosterone and raises estrogen. That’s a double whammy no guy wants! And alcohol also impairs the liver that is critical for processing estrogen and managing the amount of free testosterone that is made available in our body. Limit alcohol consumption to two drinks or less per day to help keep your liver healthy and your T levels up.
- Take supplements that can help boost nitric oxide and promote better energy and sexual health. Supplements like EveryDay Male® contain ingredients that have been separately shown in the studies to help promote strength, libido and peak performance. These ingredients can work together to help increase blood flow, promote natural free testosterone levels, and boost sexual health.
6 reasons men should not take testosterone therapy
Here are the six types of men who should definitely not take testosterone therapy unless they have eliminated and/or addressed all the lifestyle factors that could be causing their symptoms. These are the men upon whom all the Internet, magazine, and TV ads are focused. Are you one of them?
- Low T and symptoms: Make lifestyle changes that are relevant to you.
- Low T and no symptoms: Make lifestyle changes that are relevant to you.
- Low T, symptoms, and overweight. Make lifestyle changes that are relevant to you, with special attention to your weight. Men who are overweight and who drop their excess pounds can experience a significant rise in their testosterone levels. A study of nearly 900 men with prediabetes showed that weight loss reduced the prevalence of low T by nearly 50 percent. Without doubt, this is the #1 foundation of L-therapy.
- Normal T and symptoms. Make lifestyle changes that are relevant to you.
- Normal T, symptoms, and sleep deprived. Make lifestyle changes that are relevant to you, with special attention to sleep. A study in the Journal of the American Medical Association reported on the impact on testosterone levels when men were sleep deprived. The authors found that T levels declined by 10 percent to 15 percent among men who were sleep deprived for one week. Adequate sleep (7-8 hours nightly) is absolutely necessary for healthy production of testosterone.
- Cosmetic/vanity reasons: Be realistic. Do you really think testosterone therapy will make you look like the guy in the Cenegenics ads at 65? Even if such therapy did marginally help, are you willing to risk the serious side effects associated with its use? The friend I mentioned above that takes T for cosmetic reasons is a newly single Newport Beach guy on the dating hunt. He was already 11% body fat before he started T therapy – and he wanted to get to 9%. And you know what – he looks no different! And he is potentially setting himself up for a lifetime of health challenges and side effects.
Whether your T is 200 or 1000 ng/dL is irrelevant – what matters is how you feel. I know guys with clinically low testosterone that are bouncing off the walls with energy; and others with high T that act depressed and lethargic. If you are experiencing any of the classic symptoms of low testosterone or you think you need to “treat” low T, the answer you are looking for is not T therapy; it’s L therapy—lifestyle changes. Take a look at what you can personally change that will have the greatest impact on your energy and sexual health – and commit to a program today.
Read more in our Low T Health Center.
CBS News. Testosterone decline: Not inevitable with age? 2011 Jun 11
Leproult R, van Cauter E. Effect of week of sleep restriction on testosterone levels in young healthy men. JAMA 2011; 305(21): 2173-74