Confused About T? You Should Be!

Posted on by Paul Turek, MD

Is it right for me? Is it good for me? It is life’s elixir or a dram of Shakespearean poison? Welcome to the trouble with testosterone that we’re having at the moment.

The T Buzz

Let’s start with how you might come to know T. Take a look at the most popular “tool” used to screen men for low T:

Having trouble with erections? Sex drive down? Falling asleep after dinner? Are you sad or grumpy? Have you lost height? Lost strength? Lost energy? Not playing sports as well? Enjoying life less? Work suffering?

Honestly, you have to admit, anyone can have these issues even after a brutal workweek. Not only that, dozens of other diseases can cause these symptoms. And finally, none of these symptoms are unique to low T. So, part of the rub here is that this screen for low T isn’t very good. Another problem is that this “tool” is also ever so conveniently used by the pharmaceutical industry to advertise T products. We wish they would advertise weight loss, diet or stress reduction strategies instead, but they don’t. They sell T. Better living through chemistry.

Low T Epidemic

So, do we really have a low T problem in our country? Short answer: Yes.

  1. By age 80, a man’s testosterone level is about 20% of that in his youth.
  2. The decline in T occurs gradually, generally starting in a man’s mid-30s.
  3. It is estimated that anywhere from 5 million to 15 million U.S. men currently have low T levels.
  4. Low T has been associated with loss of stamina and lean muscle mass, reduced sex drive, anxiety, depression, osteoporosis and cognitive decline. In other words, low T is associated with lower quality of life.
  5. In one recent study, low T may also be associated with a shorter life span.

Reality Check

At the end of the day, though, the hundred million dollar question is: Does replacing low T really help? Well, it depends what you’re trying to help. If you want more muscle, then yes. If you want a better erection or libido, then maybe. If you want to live longer…well we just don’t know. Here are the hard clinical facts about T replacement:

  1. We still debate when to treat low T because there is no consensus about what T number is normal and what’s low.
  2. Clinicians shouldn’t just treat a number. There has to be symptoms for the treatment to work.
  3. Many changes occurring in older men are often incorrectly blamed on decreasing T-levels. Simple frailty is also pretty common.
  4. Side effects can occur with T replacement. These include worsening sleep apnea, prostatic enlargement, and breast tenderness, all of which can reduce quality of life. Infertility and soft testicles is the rule. Polycythemia or blood doping can lead to strokes, also not great for longevity. And what about the latest news about heart attacks occurring in men >65 years old after T replacement. Lastly the relationship between T levels and prostate and breast cancer are unclear.

Great. Now what? A little history might add some perspective here. Paracelsus, the 16th century Renaissance physician who pioneered the use of chemicals and minerals in medicine may have called it just right when he said: “The dose makes the poison.” Feel free to watch all the low T ads on TV that you want, but definitely talk with your doctor about T replacement before you decide that you need it.
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