Every year I get clients and non-clients asking me my thoughts on testosterone replacement therapy for men. Several people also ask if I will write an article on it someday. Well, this is that article.
Hormone replacement therapy for men and women has come a long way in the last half-decade or so. I am more comfortable writing about this topic now than I was previously. One of the fastest growing areas in medicine today is the use of the testosterone therapy in men, particularly during the middle years — for good reason.
The truth is that testosterone is involved in so many biological functions for men that it is difficult to come up with a biological system that is NOT affected by testosterone! As such, testosterone is considered one of the “master” hormones. It is important for optimal health function in many ways beyond just sex drive. Experts are now considering testosterone as not just a gonad hormone but a brain hormone as well (Morgantaler 2013)
Yes, testosterone levels decline with age. Some people argue that since this is a “normal” part of aging then it should just be accepted instead of treated. I find that outlook a bit silly and myopic. It’s like saying dementia and Alzheimer’s are a part of aging and should be accepted instead of treated.
I think anything that enhances quality of life should be considered for anyone. There are things to accept about aging and things to rail against about it. Just because some things are “natural” as we age doesn’t mean we should resign ourselves to accepting “all” of them, especially if there are treatments that are relatively harmless, effective and helpful to quality of life. Telling people to accept natural changes for the worst is like telling people not to where eyeglasses if their vision starts to suffer. We have the technology and resources to enhance quality of life in many arenas. Testosterone treatment falls into this category, as far as I’m concerned.
I find it also tremendously hypocritical that we live in a day and age where everyone will go out and get Botox and everything else to look better on the outside, in an effort to combat their own nature and their own aging, but then people have “a problem” with medical intervention to feel better on the inside. That makes no sense.
Testosterone Replacement Therapy and Its Effects
Testosterone obviously affects the male libido and sexual performance, but its effects go much, much deeper than this. Testosterone also affects mood, thinking, muscle and fat distribution, and your sense of vitality and well-being. Talk about triangle of awareness! It affects the mental, emotional, and physical elements of existence. Testosterone has direct and indirect effects on all of these sides of the triangle of your wellness.
Testosterone treatment is safe, and it’s easy to screen for as well. Common symptoms of low testosterone or signs of low testosterone are of course low libido, low energy, low overall vitality, weak erections and chronic fatigue, tiredness, sluggishness. All of these would tell you to ask your doctor for a blood test to include all indices of testosterone.
These symptoms of low T are often confused not just with depression, but with low thyroid as well. Very often, the two conditions can co-exist, one negatively impacting the other.
The previous belief that testosterone is risky for prostate cancer is false. Even taking testosterone AFTER prostate cancer treatment is now considered safe. A 2004 study reviewed over 200 medical articles and could not find a single one that showed a compelling argument for connecting high levels of testosterone with prostate cancer. Yet this myth pervaded the medical community for decades until recently. This is one reason it has taken so long for the medical community to come around and endorse testosterone therapy for Low-T treatment. One of the other reasons of course is because of a backlash against rampant use and abuse of performance enhancing drugs among athletes, bodybuilders, and recreational exercisers.
Many things have just gotten in the way of doctors prescribing testosterone for positive uses for patients with Low-T. This tide is now turning in favor of treatment. I have seen dramatic positive changes in my clients who I recommend to go see a doctor or better yet, get a referral to see an endocrinologist or urologist. They get diagnosed with Low-T, treated with testosterone and practically everything about how they feel changes for the better in a short-time. They even become more consistent and committed to their diet-strategy and training programs!
The symptoms of Low-T are numerous. Most men who will experience Low-T to a degree where it effects their quality of life, and they'll usually be men in their mid-forties or older. It is far more common than many of you know, with estimates being that about 40% of men over the age of 45 have levels of testosterone so low that treatment would help them immensely.
A common symptom of Low T that is very hard to diagnose because it is so general is this: It’s not so much that you feel “bad” but that you don’t feel great, either. You don’t feel like your former self for a long period of time, but you chalk it up to other things, like age, stress, lack of sleep, other commitments. You often just feel tired, lazy and some men experience emotional apathy alongside these physical effects.
These symptoms of Low-T can also be practically identical to what is called Dysthymia. PubMed defines dysthymia as a mood disorder consisting of the same cognitive and physical problems as occurs with depression, but with less severe, and longer-lasting symptoms. This is why depression and various mood disorders are often confused with low-T. But individuals with depression often feel helpless and hopeless and Low-T is not marked by that distinction. With Low-T you just experience a more “flat-lined” existence, just overall more blasé than before.
Here are some of the more common symptoms and experiences of men with Low-T: you start to experience low to very low libido (desire for sex). Your strength and frequency of erections diminish as well. This isn’t always just an “Erectile Dysfunction” issue solved with Viagra or Cialis. Sometimes these ED meds are treating symptoms, not causes.
Men with Low-T will experience less morning erections. As most men know nocturnal or morning erections are common when testosterone levels are optimum, like when you were younger. Some men can experience trouble with orgasms. But to be clear, it’s not just the sexual symptoms that mark Low-T. This is where so many men get off track.
Overall energy levels are also affected by Low-T. Do you feel more tired than before and more tired than you think you should? And what about your daily levels of enthusiasm? Are you enthusiastic about your day, about working out, about other activities you enjoy, or used to? Does everything seem kind of muted or dulled to you? Like you don’t get excited and “up” for things that you used to get you going? And what about the terms virility and vitality? Do you feel you have less of both of them in a noticeable way? Furthermore, often you yourself don’t think you feel grumpy or less of a joy to be around – but the people in your life might notice such things. There are physical differences as well of course with Low-T. Muscles look softer, you can put on belly fat around the waist more easily. And while yes this can happen simply because of aging, it can also be a symptom of Low-T; if this symptom exists in combination with some of the other symptoms I listed.
Again, with Low-T not all symptoms are sexual, and even the sexual ones may not be so pronounced.
No one will have all the symptoms; but the more of these symptoms you do have; the more likely testosterone treatment can help.
When testosterone levels drop far enough, men can experience hot flashes just like women do. Men can experience clamminess, cold sweats and sweatiness in general. Low-T can even have effects on posture. This makes sense if you think about. If you are tired, cloudy-headed, and listless, you are more likely to slouch than you are to stand up straight.
These symptoms of Low-T can come on slowly, often barely noticeable at first. Because of that, some men will let “not feeling like themselves” go on for 5 years or more before thinking there may be a reason to get checked out.
A blood test may not tell the whole story. Yes, a blood test can easily show when testosterone levels are beyond the lower range of normal. This one is easy to diagnose. However, when blood tests reveal “low range normal” this still may indicate Low-T and that a person could benefit with testosterone treatment.
Many endocrinologists/urologists speculate that too many family doctors are dismissing treating Low-T just because blood tests indicate testosterone as being in the “normal” range – even though it’s in the low normal range. Many labs will only mark a blood test for being “low” testosterone if the test is in the VERY LOW range only and outside the reference range. This sometimes leads to ignoring the fact that a man still exhibits all the regular symptoms of Low-T. If testosterone is in the low-normal range, and if the symptoms of Low-T are present, then treatment to bring testosterone levels back to mid-normal range or higher, may be in order. As urologist Dr. Morgentaler points out, “Men exhibiting Low-T symptoms but with just below-normal testosterone levels; these men respond just as well to treatment as men with unquestionably low levels of testosterone do” (2013 198)
Within a few weeks of treatment you feel like you have your true self back again. Energy, mood, enthusiasm, libido, they are all “up” again instead of flat-lined. Your head is clearer and less foggy. You feel the “essence of the real you” again. Of course there can be physique effects as well, but more of a correcting the effects of Low-T than of anything like a “steroids effect” or anything of that nature. People in your life will notice the positive effects and positive changes in mood and attitude as well.
Now I am not a medical doctor and don’t claim to be a medical expert in this area. But I am a keen observer and note-taker. My “opinion” is that daily testosterone use as in gels is better than the twice-monthly or so injections. Some endocrinologists and experts in this area, suggest that if you are going to go the injections route then weekly injections at a lower dose make better sense than a higher dose every three weeks or so. As Dr. Morgentaler said “Three weeks may be too long between injections. Nearly all men are back to their Low-T levels by ten to fourteen days, and in some men the testosterone levels can really bottom out after that.” (2013 p. 197.)
The fact is Low-T is common in middle-aged men and men can benefit from testosterone treatment. PERIOD. When it works, and it almost always does, you feel whole again, and you feel better in many other ways than just simply an improved libido and better erections. You function better both as a man, and as a person. And that is worth considering.
Testosterone treatment is NOT the same as performance enhancing drugs use. Let’s be clear about that. They are entirely different things. Testosterone treatment for Low-T helps get men to regain lost physical, mental, and emotional vitality and energy. It improves libido and erection quality. It can increase muscle mass and strength, which in themselves will combat the effects of aging in other ways. Testosterone treatment can also strengthen bones and improve cognition and mood. Testosterone treatment gives men their virility back.
Now, not everyone will respond “fantastically” to testosterone replacement therapy. But if this is so, this is often a dose related problem. Many doctors still under-prescribe when it comes to effective doses. But again, I am NO doctor. This is just my opinion. But as Dr. Morgentaler put it in his book, “As I see it, Low-T is under-recognized, underdiagnosed, and undertreated. In my own practice I have seen far too many men with Low-T who had been discouraged from trying testosterone therapy – or they were told they didn’t have the condition. Yet, many of these men responded to testosterone therapy beautifully. And they feel they are healthier and happier, in addition to being better sexually. Now that the fear of prostate cancer from testosterone therapy is finally waning, there is no good reason to deprive men of a treatment that can help them regain their mojo!” (2013, p. 199)
For any of you men over 40 reading this (or their spouses) if you experience any of the symptoms I’ve outlined above and you just haven’t felt like yourself for a long-time; then why not go get checked out and have a discussion with your doctor about testosterone treatment. You may end up wishing you had done this sooner.
DeWolf, W.C. et al, “Incidence of Occult Prostate Cancer Among Men with Low Total or Free Serum Testosterone,” Journal of American Medical Association, 1996
Morgentaler, A. Testosterone for Life: Recharge Your Vitality, Sex Drive, Muscle Mass, and Overall Health, 2009
Morgentaler, A. The Truth About Men and Sex, 2013
Morgentaler, A. “Testosterone Replacement Therapy and Prostate Risks: Where’s the Beef?” Canadian Journal of Urology, 2006