Mercy's Dr. John-Paul Rue Discusses What You Should Know About Testosterone

Testosterone is a naturally occurring male hormone, or androgen. Both males and females produce it, although males produce more.  It is largely made by the Leydig cells in the testicles. Testosterone is responsible for regulating sperm production, sex drive, bone mass, fat distribution muscle bulk and strength and red blood cell production. 

The normal levels of testosterone fall in males by approximately 1.6% per year.  When your testosterone level falls to a certain level, this can lead to the diagnosis of hypogonadism.  The symptoms of hypogonadism are familiar and often considered a part of normal aging: decreased libido, diminished erectile quality, mood changes, depression, decreased cognitive function, fatigue, skin changes and decreased body hair, increased abdominal fat, decreased bone mass. These are often associated with low levels of testosterone.

Testosterone supplements are touted to increase your level of testosterone and thus increase sex drive, bone mass, muscle bulk and strength.

It’s important to distinguish between testosterone supplementation (i.e. taking additional testosterone or testosterone precursors into your body for a medical condition from low levels of your own testosterone) and testosterone supplements, which are advertised to boost your own body’s production of testosterone. Basically none of the supplements do this.

The supplements are mainly targeted at men.  They are advertised to improve libido and sexual performance and help build stronger and bigger muscles. It has been estimated that there are between 1-2 million in the US who use testosterone or testosterone pre-cursors and related compounds including up to 20% of college athletes, 5-10% high school males, 1.2% females, 2% junior high males, 80% of male bodybuilders and 40% female bodybuilders.  

As men age, the level of testosterone falls accordingly.  This is a normal part of the aging process.  Generally speaking, there is no medical or scientific reason to treat a low testosterone level in a male over the age of 65. The reason younger men would want to use them would be to try to build muscle. There has been a recent surge in use of testosterone enhancing supplements among men. We all want to look better, be stronger and have all of the positive side effects of testosterone. But supplements can’t provide this short cut to fitness or performance. 

Testosterone supplements are advertised to improve libido and sexual performance and help build stronger and bigger muscles.  But it’s not that simple and the evidence is not there to support these claims.  Lifestyle changes can help you boost your testosterone levels naturally. Most of these changes are exactly what you would expect them to be and they make sense. Getting enough sleep, maintaining a healthy weight, staying active, and decreasing stress are all habits that make us feel better and be more healthy.  Your body’s testosterone level can adapt to your body’s needs. If you are not active, your body doesn’t need much testosterone, but if you are physically active, your body signals for more testosterone to be made. If you’re stressed, your body may actually make less testosterone as a result. 

I don’t recommend testosterone supplementation. Again, it’s important to distinguish between taking additional testosterone because of a medical condition caused by low levels of testosterone (such as hypogonadism as reviewed above) versus taking testosterone supplements. The supplements are essentially touted to be vitamins to boost your body’s production of testosterone…but they can’t do that.  Maintaining a healthy lifestyle and a healthy weight with regular exercise and regular sleep routines is the best way to stay healthy and feel better.

Men with a history of prostate cancer should not take testosterone supplements or additional testosterone supplementation as it may increase the growth of prostate cells and worsen the disease.  Testosterone can also lead to a drop in sperm production. Your body can also become dependent on testosterone.  Once you start taking it as a supplement, your body will actually slow its natural production of it. This can lead to a cycle of requiring to maintain hormone treatment. 

The supplements are sold everywhere…just like vitamins. Actual testosterone replacement therapy is a medical treatment and only available through a licensed medical provider for a specific medical condition. While some have touted the use of testosterone to boost their sports performance, without a medical diagnosis, this is illegal and considered “doping” or the use of performance enhancing drugs. 

The normal levels of testosterone fall in males by approximately 1.6% per year.  When your testosterone level falls to a certain level, this can lead to the diagnosis of hypogonadism.  The symptoms of hypogonadism are familiar and often considered a part of normal aging: decreased libido, diminished erectile quality, mood changes, depression, decreased cognitive function, fatigue, skin changes and decreased body hair, increased abdominal fat, decreased bone mass. These are typically associated with low levels of testosterone. Regarding high levels, this is somewhat controversial because the data is conflicting. There is evidence to support that additional testosterone can be a risk factor for developing or worsening prostate cancer, but some new information has cast some doubt as to whether or not this is the case.

Your doctor can order a blood test to check the level of testosterone in your body.  This level can fluctuate throughout the day.  If you believe that you have some of the symptoms of low levels of testosterone, it’s important to have a discussion about this with your doctor or medical provider. That discussion needs to include a frank discussion about your lifestyle, habits, level of fitness and of course underlying medical conditions and medications that you are taking.

There’s no short-cut to a healthy body and life.  Many of the symptoms associated with low levels of testosterone are part of the normal aging process. By staying fit, exercising regularly, decreasing stress and staying healthy in general, you can minimize or control the symptoms and improve your overall health and lifestyle.

References:

1. Yassin DJ, Doros G, Hammerer PG, Yassin AA. Long-term testosterone treatment in elderly men with hypogonadism and erectile dysfunction reduces obesity parameters and improves metabolic syndrome and health-related quality of life. J Sex Med. 2014 Jun;11(6):1567-76. doi: 10.1111/jsm.12523. Epub 2014 Apr 8. PubMed  PMID: 24712761.
2. Spitzer Matthew, et al. Risks and benefits of testosterone therapy in older men Nature Reviews Endocrinology 9, 414-424 (July 2013) | doi:10.1038/nrendo.2013.73