Ubiquitous low T ads feature an aging man who "enjoys disco with his shadow," as Stephen Colbert has said. (1) A woman is always part of the ad, with a ready-for-anything, until-death-do-us-part look in her eye.
These ads target men with dampened sex drive and decreased energy, and they work. Doctors wrote 5.3 million prescriptions for testosterone replacement gel in 2011 vs. just 1.8 million in 2008. (2) Unfortunately, in some men, the drug also increases heart attack and stroke risk (3), worsens sleep apnea and cuts off testosterone production permanently.
But prescription testosterone is unnecessary and dangerous for women and children, not just most men. Very few medical prescriptions given to a man affect a female partner and family so intimately and affect desired intimacy and passion in just the wrong way.
The reason: This prescription applied as a gel is unique in its tendency to rub off on others accidentally during bare-chested contact, from embracing to sexual activity.
Here is the warning that appears on AndroGel, the leading prescription testosterone gel (4):
- Women who are pregnant or who may become pregnant should avoid contact with the area of skin where AndroGel has been applied.
- Stop using AndroGel and call your health care provider right away if you see any signs and symptoms of puberty in a child, or changes in body hair or increased acne in a woman, that may have occurred through accidental exposure to AndroGel.
- AndroGel may harm the unborn or breast-feeding baby.
Gel and roll-on testosterone are slowly absorbed and stay on the skin for at least eight hour. Only 10 percent of the testosterone dose applied on the skin is absorbed. The rest stays on the skin until washed off. (2) Pharmaceutical companies advise application to shoulder, upper arms, stomach, and underarms. (4)
By the way, be careful with the post-coital smokes: The gel is flammable. (5)
Women exposed to testosterone gel can show hirsutism, irregular menses and mood changes.(2)
Children up to age 7 years exposed to testosterone gel have shown enlargement of genitalia, precocious pubic hair development and inappropriate aggressive and sexual behavior, according to FDA reports. (2)
At least two children have required clitoral reduction surgery after exposure.
(2)
Prior to the year 2000, testosterone was only available by injection, pellet implants, patches and pills. Since then, the vast majority of prescriptions written have been for testosterone gel.
The FDA called out the threat of "secondary exposure" with a black box warning for AndroGel and Testim in 2009 (6) and is re-investigating testosterone products because of the heart attach and stroke reports, (7) as is its EU equivalent, the European Medicines Agency. (8) But because the drugs are overwhelmingly prescribed for men, and prescriptions are on such a tear, some women do not know about the warnings.
The FDA advises adults -- men and women -- to take several personal precautions:
- Wash your hands thoroughly with soap and water if you help your man apply the gel or touch it.
- Watch your own naked skin exposure, and that of kids for at least eight hours after application; have your man wear a shirt once the gel is dry.
- Make sure your partner washes the application site thoroughly with soap and warm water prior to anticipated skin-to-skin contact. (2)
These precautions are important, but should be unnecessary, because most men who get the drug actually don't need it.
Men can raise their own testosterone levels (and energy, sex drive and self-confidence) with what they eat, how they work out, how well and long they sleep and how they handle stress.
In one study, men who lost an average of 17 pounds raised their testosterone level by 15 percent. (9) High blood pressure, high cholesterol and high blood sugar often come down with the right foods as well.
If behind every successful man stands a powerful woman, her influence over the state of his health is yet to be fully appreciated. In fact, protecting her partner's health may be the most consequential role she can assume in the relationship.
Take charge by making these five changes to your own diet and every day habits to help the men in your life so they can get healthier, stronger and happier naturally.
- Use gender-specific phrases ("I don't want to lose you" and "The kids really liked your dinner tonight" worked well in our studies). (10)
- Make the right food available at home and elsewhere (e.g., nuts, hard boiled eggs, vegetables and water instead of chips, crackers, cookies and soda).
- Stock the fridge and pantry with food that is fuel, instead of starchy, sugary food that increases obesity and turns men's testosterone into estrogen by building belly fat. Deep belly fat enzymes in men convert testosterone to estrogen.
- Research your partner's doctor and your own, and make a doctor's appointment right away for a man if he has erectile dysfunction: It's commonly an early warning sign of heart disease.
- Make an annual doctor's appointment for a man, especially one who is obese (a man's waist should be half his height or less), or who has a family history of heart disease or stroke.
Now, I'd like to hear from you.
How have you protected your partner's health?
Which tactics have been most successful in helping to help a man get healthier?
What changes are easiest to help a man make?
John La Puma, M.D.'s most recent book is REFUEL: A 24-Day Eating Plan to Shed Fat, Boost Testosterone, and Pump Up Strength and Stamina (Harmony/Crown, 2014). A practicing physician, founder of Chef Clinic, host of the popular PBS Series "ChefMD Shorts" and co-founder of ChefMD.com, he is a two-time New York Times bestselling author. Earlier this year, he wrote "Don't Ask Your Doctor About Low T" for the New York Times. Subscribe to his free newsletter and private mailing list.
References:
1. The Colbert Report, October 2012: Cheating Death
http://thecolbertreport.cc.com/videos/idoutl/cheating-death---low-t
2. FDA Drug Safety Newsletter Postmarket Reviews - Volume 2, Number 3, 2009
http://www.fda.gov/Drugs/DrugSafety/DrugSafetyNewsletter/ucm189806.htm
3. Vigen R et al. Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels http://jama.jamanetwork.com/article.aspx?articleid=1764051
4. AndroGel Medication Guide http://www.androgel.com/medication-guide
5. Consumer Reports May 2013. AndroGel and the other testosterone gels can light your fire literally. http://www.consumerreports.org/cro/news/2013/05/androgel-and-other-testosterone-gels-can-light-your-fire-mdash-literally/index.htm
6. FDA Medwatch: AndroGel (testosterone gel) 1% for topical use; Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER)
http://www.fda.gov/safety/medwatch/safetyinformation/ucm186386.htm
7. Drug Safety and Availability FDA evaluating risk of stroke, heart attack and death with FDA-approved testosterone products http://www.fda.gov/drugs/drugsafety/ucm383904.htm
8. Review of testosterone-containing medicines started 11 April 2014. http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2014/04/WC500165222.pdf
9. Mazur A et al. Is Rising Obesity Causing a Secular (Age-Independent) Decline in Testosterone among American Men? PLoS One. 2013; 8(10): e76178
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797769/
10. La Puma J. REFUEL: A 24-Day Eating Plan to Shed Fat, Boost Testosterone, and Pump Up Strength and Stamina (Harmony/Crown, 2014) http://drjohnlapuma.com/Refuel