Many Men Risk Their Health by Taking Testosterone When They Don’t
Need It
February 21, 2014
Story at-a-glance
-
Testosterone plays many roles in men’s health. Besides affecting
your sex drive, it also helps maintain muscle mass, bone
density, red blood cells, and a general sense of well-being
-
Direct-to-consumer drug advertising is driving men to use
testosterone when they’re really not good candidates for it
-
Testosterone prescriptions have tripled since 2001, and men in
their 40s represent the fastest-growing group of users. Half of
them do not qualify for a diagnosis warranting the prescription
of testosterone
-
Recent research found that men aged 65 and older who took
testosterone DOUBLED their risk of having a heart attack within
the first three months of use
-
Chronic stress can result in hypercortisolemia, which inhibits
testosterone production. Stress relief, diet, and high intensity
exercise are three potent lifestyle strategies that can reverse
low testosterone
By Dr. Mercola
The male sex hormone testosterone plays many roles in men's
health. Besides affecting your sex drive, it also helps maintain
muscle mass, bone density, red blood cells, and a general sense of
well-being.
Beginning around age 30, a man's testosterone levels begin to
decline, and continue to do so as time goes on—unless you
proactively address your lifestyle. Symptoms of declining
testosterone levels can include:
- Decreased sex drive
- Erectile dysfunction and/or problems urinating
- Depression
- Difficulties with concentration and memory
- Weight gain and/or breast enlargement
Unfortunately, direct-to-consumer drug advertising, which is
permissible in the US, is driving men to use testosterone when
they're really not good candidates for it. There are
studies showing that
testosterone therapy can be quite helpful and beneficial, but
that's in men who actually have very low testosterone.
Lacking energy and sex drive does not automatically mean you have
severe testosterone deficiency warranting taking this hormone. Yet
"low T" has become a well-recognized mantra—created by some
pharmaceutical PR department—even though there's no hard and set
"normal" testosterone level.
Your Lack of Libido Could Be Due to Other Hormonal Imbalance
For example, a recent study published in the New England
Journal of Medicine (NEJM)1
found that there were significant individual variations in the
amount of testosterone required for any particular man to maintain
lean body mass, strength, and sexual function.
Other hormones, such as estrogen, also play a critical role in
men's health, so the heavy focus on testosterone may be
inappropriate. The NEJM study2
determined that while testosterone deficiency accounted for
decreases in lean mass, muscle size, and strength, estrogen
deficiency was the primary culprit when it came to increases in body
fat.
Both hormones were found to be important for sexual
function, and a deficiency in either had a negative impact on the
men's libido.
Please note that men are NOT advised to take estrogen replacement
therapy, as this could cause feminization, such as enlarged breasts.
As your testosterone levels rise, your body will automatically
produce more estrogen,
So the key is to maintain your testosterone level—ideally by
incorporating the strategies I will discuss below. Interestingly,
simply having more sex has also been shown to boost testosterone
levels in men.3
As reported by PeakTestosterone.com:
"One 1992 study4
examined four couples on days that they did and didn't have
sexual activity... [T]hey found that testosterone levels
increased on nights after sexual activity and did not on nights
where there was no intercourse. The authors noted that their
study showed that it was likely sex that increased testosterone
and not the other way around."
Low Testosterone—An Invented Condition?
It's important to realize that all of this fake "low T"
advertising is merely a PR strategy to sell an expensive treatment.
In 2012, prescription testosterone gels generated over $2 billion in
US sales. Abbott Laboratories alone spent $80 million on seductive
direct-to-consumer advertising for its testosterone product AndroGel
that same year.
According to a survey by CMI/Compass, 63 percent of physicians
polled feel that drug ads misinform patients.5
And truly, it's worth keeping in mind that advertising is far from
realistic or even truthful in most cases. It's about creating a
perceived need where there might not be one, in order to sell a
product. As reported by the New York Times:6
"In the view of many physicians, [low testosterone] is in
large part an invented condition...
Once a niche treatment for people suffering from hormonal
deficiencies caused by medical problems like endocrine tumors or
the disruptive effects of chemotherapy, the prescription gels
are increasingly being sold as lifestyle products, to raise
dipping levels of the male sex hormone as men age."
Many people feel so bad they're willing to take just about
anything to feel better. Unfortunately, many fail to realize that
that "something" probably isn't a drug treatment. Instead,
flagging energy levels may be an indication that you're eating too
much processed food. Perhaps you're not exercising enough, or
failing to address chronic stress or lack of sleep.
How Stress Affects Your Testosterone Levels
Chronic stress may in fact be a major contributing factor to
decreasing testosterone levels. Stress, when chronic and
unaddressed, can result in hypercortisolemia, which in and of itself
inhibits testosterone production.7
The cortisol produced in response to stress also interferes with
your insulin. As described by chiropractor Kyl Smith, D.C.:8
"This is seen when healthy men exhibit fasting plasma
glucose concentrations and degrees of insulin resistance that
are directly correlated with fasting plasma cortisol
concentrations(i.e., when cortisol goes up, insulin goes up,
insulin resistance goes up, and insulin sensitivity
correspondingly goes down)...
The subject of insulin and insulin sensitivity ties
directly into testosterone, as 'testosterone and insulin status
are also directly correlated.' Among adult men, the insulin
secretion rate and fasting plasma insulin concentration are
inversely proportional to serum testosterone concentrations
(i.e., high insulin levels are associated with low testosterone
and low insulin levels are associated with high testosterone),
while whole-body insulin sensitivity is shown to be positively
correlated with serum testosterone concentrations.
In other words, in men who have challenges with
high postprandial blood sugar levels, simple carbohydrates that
evoke an insulin spike/increase will sabotage the production of
healthy testosterone." [Emphasis mine]
Testosterone Is Widely Overprescribed
According to the Endocrine Society, which is responsible for
setting the clinical guidelines for testosterone replacement
therapy, testosterone should only be given to men with persistent
symptoms and "unequivocally low testosterone levels," a condition
known as hypogonadism. According to a 2012 study9
looking at the sensitivity and specificity of total testosterone
(total T) as an indicator of biochemical hypogonadism found that a
total T level below 150 ng/dl is indicative of hypogonadism, while
levels above 350 ng/dl excludes the condition in most cases.
Despite that, testosterone prescriptions have tripled since 2001,
and men in their 40s represent the fastest-growing group of users.
Only about half of men taking testosterone have an actual diagnosis
of hypogonadism. Even more curious, recent findings10,
11,
12 also indicate that 25 percent of men given a
prescription for testosterone did not even have their levels tested
prior to receiving a prescription, and of the remaining 75 percent,
it was unclear as to how many actually had a testosterone
deficiency.
In short, there appears to be an awful lot of men out there
taking testosterone who probably shouldn't. Using hormones as a
"cure-all" is a risky proposition, especially if your problems are
related to lifestyle opposed to an actual medical condition that
severely impairs your hormone production. What most men need is
really a lifestyle change, in order to optimize
their body's natural secretion of testosterone and other hormones.
Recent Research Highlights the Dangers of Testosterone Misuse
According The result was similar in younger men diagnosed with
heart disease. The study was prompted by a 2010 clinical trial that
was shut down before completion due to the increase in heart-related
problems occurring in the testosterone treatment group.13
Other research14
published earlier this year found that testosterone replacement
therapy did not appear to have any positive effects on the
cardiovascular health of men who took it, noting that the
"cardiovascular risk-benefit profile of testosterone therapy remains
largely evasive."
Interestingly, the analysis does suggest that low
testosterone and heart disease might both be caused by "poor overall
health," as stated by lead researcher, Dr. Johannes Ruige.15
This, again, is why I recommend focusing your efforts on healthy
lifestyle strategies such as exercise rather than taking synthetic
hormone replacement, the risk/benefit ratio of which is still
largely unknown.
The latest results have caused enough concern that the US Food
and Drug Administration (FDA) has launched a safety review16
to ascertain the safety of testosterone therapy. In the meantime,
the FDA has instructed doctors to "consider whether the benefits of
FDA-approved testosterone treatment are likely to exceed the
potential risks of treatment."
Some Experts Disagree
Dr. Jen Lauda writing in the Feb 7 2014
newsletter summarizes the objections some physicians have with this
study. "There are many problems with the data in this study and others
like it that have lead to attention-grabbing headlines about how
treatment of low testosterone levels may put men at undue risk. Similar
to a November 2013 JAMA study of testosterone risks, However some have
said that the featured study has multiple flaws that make its
conclusions essentially meaningless as the study assess did not test
testosterone levels of patients before and during therapy.
There are other important blood tests that should be done that were not
being done during the treatment of the VA men or in the current study,
including blood counts and estrogen levels. Higher red blood cell counts
and higher estrogen levels are known issues that may occur in men given
testosterone therapy. Without assessment of testosterone levels, red
blood cell counts and estrogen levels prior to and during therapy, it is
impossible to tell if a patient is a proper candidate for therapy and if
they are tolerating the therapy well. Physicians should be educated on
the possible issues they may encounter with patients on testosterone
therapy, including higher levels of red blood cells and elevated levels
of estrogen.
Physicians should monitor their patients' blood cell counts and estrogen
levels on testosterone therapy to assess for these risk factors for
cardiovascular disease. If a patient has a high red blood cell count,
the dose of the testosterone can be decreased or the patient can be sent
for blood donation to reduce the high red blood cell count and thus any
increased risks of clots or heart attacks. Additionally, high estrogen
levels may increase the risk of heart attack and stroke. There are
medications that can be prescribed to control high estrogen levels and
keep estrogen in the proper, low risk range. These precautions need to
be used when prescribing testosterone therapy and studies need to be
done reflecting results of testosterone use when these precautions are
followed.
Additional concerns are that the researchers compared the groups of men
started on testosterone therapy to men who were started on PDE5
inhibitors and found a lower risk of heart disease in the PDE5 inhibitor
group. PDE5 inhibitors are drugs used to treat men with erectile
dysfunction -- Viagra and others are in this class. The authors state
they used this group so there would theoretically be an increase in
sexual activity in both groups. They ignored one very important point,
though. PDE5 inhibitors work in many tissues throughout the body,
including having significant positive effects on the cardiovascular
system. Two of the PDE5 inhibitors have recently been approved for
treatment of idiopathic pulmonary hypertension because of the ability of
PDE5 inhibitors to relax blood vessels. A new study out this month in
the Journal of Cardiovascular Pharmacology and Therapeutics states that
PDE5 inhibitors have potential as cardiovascular drugs in patients with
coronary artery disease and even possible improvement in heart failure
patients.
With the data that PDE5 inhibitors can decrease the risk of heart
disease and help to relax blood vessels in men with heart disease, how
can the authors of the testosterone therapy study possibly think that
men on PDE5 inhibitors would be a good control group against the men
placed on testosterone therapy? The results of the Plos One study run
counter to a large body of literature of the last 20 years that supports
testosterone treatment as an important therapy that can improve
cholesterol levels, decrease blood sugar levels, reduce body fat and
increase lean muscle mass, all factors that would reduce the risk of
heart disease. A new review article was published in December 2013 in
the esteemed Journal of the American Heart Association with the goal of
providing a comprehensive review of the clinical literature that has
examined the associations between testosterone and cardiovascular
disease.
Well over 100 studies were reviewed, and the authors concluded that low
levels of testosterone are associated with higher rates of mortality and
cardiovascular- related mortality, higher rates of obesity and diabetes.
Additionally, the severity of disease correlated with the degree of
testosterone deficiency. Testosterone therapy has been shown to relax
coronary arteries and improve ability of patients with congestive heart
failure to exercise. Testosterone therapy has been shown to lower blood
sugar in diabetics and to lower body mass index in obese patients.
Finally, studies have associated lower testosterone levels with thicker
walls of some of the major blood vessels. This thickening increases the
risk of atherosclerosis thus leading researchers to conclude that low
levels of testosterone increase the risk for atherosclerosis.
All of these factors point to the conclusion that optimal testosterone
levels decrease the risk of cardiovascular disease. Testosterone therapy
can be an excellent way to help men to enhance their quality of life and
decrease their risk of multiple diseases, as shown in many studies.
Importantly though, the therapy should not be undertaken lightly and
should be properly monitored by a hormone specialist that is well versed
in the risks of therapy and the treatment of possible side effects for
patients to have optimal benefits from the therapy."
Lifestyle Factors Influence Your Hormone Levels
Despite the above objections it would seem a more conservative
approach would be warranted. While a man's testosterone level does
decline with age, starting around the age of 30, there are many
other factors that play a role. Think of generations past, when men
were active and healthy well into old age. Clearly, it's possible to
grow old without losing your "oomph." It really boils down to
lifestyle. Diet and exercise are critical factors. But chemical
exposures, including prescription drugs like
statins, can also play a role by having an adverse effect on
your testosterone production. And, as reported in another more
recent New York Times17
article:
"Testosterone appears to decline naturally with aging,
but internal belly fat depresses the hormone further,
especially in obese men. Drugs like steroids and opiates
also lower testosterone, and it's suspected that
chemicals like bisphenol A (or BPA,
commonly found in plastic food containers) and diseases like
Type 2 diabetes play a role as well." [Emphasis
mine]
Testosterone production follows a similar decline with age as
human growth hormone (HGH), illustrated below. Fortunately, your
body has a natural ability to optimize hormones, even as you age. It
does require you to address important factors such as your diet and
exercise, however.
To Raise Your Hormone Levels, Exercise Intensely, But Briefly
Both testosterone and HGH are boosted in response to short,
high intensity exercises. I personally do not take any hormone
or prohormone supplements. Instead, I've been doing
Peak exercises for just nearly four years now, and at the age of
59, my testosterone and HGH levels are still in the normal ranges
for a young adult male without the aid of ANY prescriptions,
hormones, and hormone precursor supplements.
Keep in mind that high intensity interval training is the only
type of exercise that will help boost your testosterone and HGH
levels. A slow one-hour jog will not have this effect, so
it's critical to make sure you're exercising correctly if
you want to affect your hormone levels. Below is a summary and video
demonstration of what a typical high-intensity Peak Fitness routine
might look like:
- Warm up for three minutes
- Exercise as hard and fast as you can for 30 seconds. You
should feel like you couldn't possibly go on another few seconds
- Recover at a slow to moderate pace for 90 seconds
- Repeat the high intensity exercise and recovery seven more
times
Weight training will also have a beneficial impact on your
testosterone levels. When you use strength training for this
purpose, you'll want to increase the weight and lower your number of
reps. Focus on doing exercises that work a wider number of muscles,
such as
squats or dead lifts. You can take your workout to the next
level by learning the principles of
Super-Slow Weight Training. Whole body vibration training using
a
Power Plate is yet another effective ancillary method.
Besides raising testosterone and HGH, aerobic exercise in general
is known to benefit your heart, in part by promoting the production
of beneficial nitric oxide, which helps relax your heart and
improves blood flow.18
Recent research also suggests that skin-derived nitric oxide
metabolites may also play a key role in heart health by normalizing
blood pressure when your skin is exposed to UV rays from the sun19
--yet another reason for making sure you're getting enough sun
exposure.
Your Diet Affects Your Testosterone and HGH
While high intensity exercise is perhaps the most effective
strategy to raise your testosterone levels, your diet also plays a
critical role. First of all, if you're overweight, research shows
that simply shedding the excess pounds may increase your
testosterone levels.20
Testosterone levels also decrease after you eat sugar. This is
likely because sugar and
fructose raises your insulin level, which is another factor
leading to low testosterone. Ideally, keep your total fructose
consumption below 25 grams per day. If you have insulin resistance
and are overweight, have high blood pressure, diabetes, or high
cholesterol, you'd be well advised to keep it under 15 grams per
day.
The most efficient way to shed excess weight and normalize your
insulin levels at the same time is to strictly limit the amount of
sugar/fructose and grains in your diet, and replace them with
vegetables and healthy fats, such as organic pastured egg yolks,
avocado,
coconut oil, butter made from raw grass-fed organic milk, and
raw nuts.
Saturated fats are in fact essential for building
testosterone. Research shows that a diet with less than 40 percent
of energy as fat (and that mainly from animal sources, i.e.
saturated) lead to a decrease in testosterone levels.21
My personal diet is about 70-80 percent healthy fat, and other
experts agree that the ideal diet includes somewhere between 50-70
percent fat. I've detailed a step-by-step guide to this type of
healthy eating program in my optimized
nutrition
plan.
Another effective strategy for enhancing both testosterone and
HGH release is
intermittent fasting. It helps boost testosterone by improving
the expression of satiety hormones, like insulin, leptin,
adiponectin, glucagon-like peptide-1 (GLP-1), cholecystokinin (CKK),
and melanocortins, which are linked to healthy testosterone
function, increased libido, and the prevention of age-induced
testosterone decline.
Helpful Supplements
There are also nutritional supplements that can address some of
the symptoms commonly associated with low testosterone. Some may
even help boost your testosterone levels as well. These include:
- Saw palmetto. Besides addressing symptoms
of
low testosterone, this herb may also help to actually
increase testosterone levels by inhibiting up-conversion to
dihydrotestosterone.22
When choosing a saw palmetto supplement, you should be wary of
the brand, as there are those that use an inactive form of the
plant. According to industry expert
Dr. Rudi Moerck, what you want is an organic supercritical
CO2 extract of saw palmetto oil, which is dark green in color.
Since saw palmetto is a fat-soluble supplement, taking it with
eggs will enhance the absorption of its nutrients.
- Astaxanthin in combination with saw palmetto.
There is also solid research indicating that if you take
astaxanthin in combination with saw palmetto, you may experience
significant synergistic benefits. A 2009 study published in the
Journal of the International Society of Sports
Nutrition23
found that an optimal dose of saw palmetto and astaxanthin
decreased both DHT and estrogen while simultaneously
increasing testosterone.
- Ashwagandha. This ancient Indian herb is
known as an adaptogen, which can help boost stamina, endurance,
and sexual energy. Research published in 201024
found that men taking the herb Ashwagandha experienced a
significant increase in testosterone levels.
Ashwagandha also helps promote overall immune function, and
can help increase your resistance to occasional stress.25
It also supports healthful levels of total lipids,
cholesterol, and triglycerides already in the normal range.
While some adaptogens are stimulants in disguise, this is not
the case with Ashwagandha. It can give your morning exercise
routine a boost, and when taken prior to bed, it can help you
get a good night's sleep as well. I recommend using only 100%
organic Ashwagandha root, free of fillers, additives, and
excipients to ensure quality.
Do You Really Need Testosterone Therapy?
The take-home message is that taking testosterone if you're
otherwise healthy could jeopardize your health for virtually no
gain. And, if you're using a topical gel or cream, you're also
jeopardizing the health of anyone in your family that you end up
having skin to skin contact with. I personally do not use any
hormone or prohormone treatments as I've been successful in getting
my hormone levels in the healthy young adult range using the
protocols described above. However, if you do chose to use hormones,
it is really crucial to use bioidentical versions.
I advise using
bioidentical hormones like DHEA if you opt for this route. DHEA
is a hormone secreted by your adrenal glands, and is one of the most
abundant precursor hormones in your body. It's crucial for the
creation of testosterone and other sex hormones. However, it's
important to monitor your levels and work with an experienced
professional before you start using DHEA (or any other hormone,
bioidentical or not.) If you use trans-mucosal applications you will
likely only need a few milligrams a day, not 50mg, 100mg, or more
that is typically used. There are still questions about long-term
safety, and there's still the potential for side effects.26
I also recommend trans-mucosal (rectal) application, as this
allows for the most effective absorption, and inhibits the
production of unwanted metabolites of DHEA. All of that said, I do
NOT recommend prolonged supplementation of hormones, even
bioidentical ones. Doing so can trick your body into halting its own
DHEA production and may cause your adrenals to become impaired.
Your best bet really is to address your diet, and incorporate
high intensity exercise into your lifestyle. For even more
information on how exercise can be used as a natural testosterone
booster, read my article "Testosterone
Surge After Exercise May Help Remodel the Mind."
© Copyright 1997-2014 Dr. Joseph Mercola. All Rights Reserved.
http://fitness.mercola.com/sites/fitness/archive/2014/02/21/testosterone-prescription.aspx
|