Millions of American men resort to testosterone replacement therapies, be it a gel, patch or injection, to restore normal levels. Between doctors over prescribing as a knee-jerk reaction to the problem and pharmaceutical companies touting messages of amazing results, you can see why men are spending $2 billion a year on testosterone.
This year alone, the FDA has issues a number of warnings to physicians and male patients regarding the use of testosterone drugs, which they say may increase the risk of heart attack and stroke. They're currently urging doctors and drug makers to warn patients about the potential life-threatening risks they pose.
The FDA's warning comes after discovering that testosterone drugs are not always being used as a form of treatment for low testosterone caused by certain medical conditions, but rather to treat symptoms of low testosterone as a result of aging, such as fatigue and low libido. The FDA has not determined what benefits and safety in using testosterone products for treating symptoms of low testosterone due to aging. For this reason, the FDA wants doctors to prescribe testosterone only to men who are suffering from low testosterone that is caused by a medical condition which has been confirmed by laboratory tests.
A study published in the Journal of American Medical Association in November 2013 found a 30 percent increased risk of death, heart attack or ischemic stroke among men who were taking testosterone replacement drugs compared to men who were not taking them. Another study from the National Institute of Health found that men over 65 who were taking testosterone replacement drugs had twice as many heart attacks compared to men who were not taking them.
The FDA estimates that 1.5 million men were taking a testosterone replacement product in 2013, which is almost double the amount of men taking them in 2010. About 25 percent of these men had not been tested for or diagnosed with hypogonadism (low testosterone), meaning they were taking the drug based on symptoms, rather than a diagnosed medical condition.
Exploring Testosterone Replacement Therapy Options
Forms of Testosterone Replacement Therapy
1. Transdermal Skin Patch: Androderm is a skin patch worn on the arm or upper body, applied once a day. This may cause severe itching and fluid-filled blisters.
2. Gels: AndroGel and Testim are most commonly used and come in individual packets of clear testosterone gel. It's applied once a day and absorbed directly through the skin. AndroGel, Axiron and Fortesta also come in a pump that delivers the prescribed amount of testosterone. Natesto is a gel applied through the nose. These gels may leave skin red, irritated or itchy.
3. Testosterone Stick: Similar to an underarm deodorant, it's applied directly to the skin.
4. Mouth Patch: Striant is a tablet that is applied to the upper gum twice per day. It continuously releases testosterone into the blood through the oral tissues. Men may experience an unpleasant or bitter taste in the mouth, difficulty tasting food, stinging or swelling of the lips, and gum pain, tenderness, swelling, and irritation in the mouth.
5. Injections and implants: Testosterone can also be injected directly into the muscles or implanted as pellets in the soft tissues. The body will slowly absorbed the testosterone into the blood stream. Side effects include inflammation and pain.
6. Testosterone pills: Two of the more common formulas are called methyltestosterone and testosterone undecanoate. Some evidence has shown that oral testosterone may cause damage to the liver.
All testosterone therapy options have side effects, including:
• Increased risk of heart attack and stroke
• Stimulation of prostate tissue
• Serious blood clots
• Hair loss
• Acne or oily skin
• Mild fluid retention
• Breast enlargement
• Increased risk of blood clots
• Worsening of sleep apnea
• Shrunken testicles
• Increased aggression and mood swings
• Decrease in sperm count
The Link between Testosterone and Prostate Cancer
There's a big debate when it comes to testosterone levels and the relation to prostate cancer development. Some studies have shown a significance when it comes to both high and low levels. These may have some merit, since we know as men age they're more at risk of for the disease and their levels begin to drop. But, no solid evidence exists to prove these points. In some cases, hormonal therapy or androgen deprivation therapy is used to suppress a man's testosterone levels in hopes of shrinking the prostate cancer tumor, but this does not cure prostate cancer.
However, TRT is not recommended for men currently with low or high grade prostate cancer. If men have a nodule on the prostate (discovered during a digital rectal exam) or a PSA greater than 3, TRT should be avoided. Also, men with urinary issues, serious heart condition, liver or kidney disease should stay far away.
Of course we're all looking for a quick fix, but immediately running to the nearest testosterone clinic is not the answer. The truth is testosterone injections should never be the first line of defense when it comes to treating low T. What many men don't realize is that testosterone is a lifelong therapy. Once you're on these therapies, a physician monitors your levels every 6 months or even more frequently. It's critical to explore all your options and look to natural methods, as opposed to jumping into replacement therapy.
My recommendation to men considering TRT is to undergo a thorough prostate exam before starting any therapy, including a digital rectal exam and PSA blood test. Getting a baseline PSA before taking any TRT is critical, since it may increase after therapies begin. A urologist should monitor the PSA closely once treatments start.
A Word on Male Menopause
Male menopause is a very real condition that men can face as they age. Everything about its progression is directly linked to a decrease in testosterone levels. It's been said that testosterone is what makes men, well, men. Your testosterone is your mojo. From a healthy sex drive, high energy levels and sleep patterns to weight and emotional health, testosterone drives your quality of life. Of course, when you're "young," you're at the top of your game, right? I bet you didn't know that when men hit the age of 30, their testosterone decreases by 1 percent each year after.
Common Symptoms of Low T include:
• Increase in belly fat
• Weight gain
• Low to no sex drive (we certainly can't have that)
• Risk of depression
• Mood Swings
• Low energy
• Bone density
• Increased risk of diabetes
Size Matters When It Comes to Low T
The size of your stomach, that is. Obesity and being overweight plays a huge role in the advancement of male menopause. As men gain weight and raise their risk of obesity, testosterone levels dramatically decrease.
It's time to stop thinking of your stomach solely as a cosmetic problem but as a real organ that secretes hormones related to cardiac disease, obesity and low testosterone.
The size of your abdomen is a key player in testosterone deficiency. The enzyme, aromatase, converts testosterone into estrogen in the stomach. Body fat rapidly increases this process.
As testosterone converts to estrogen, side effects such as man boobs may occur. Losing weight is the key to improving testosterone levels and fighting male menopause.
Fight Male Menopause and Increase Your Testosterone
When men turn 50, they should begin to check their testosterone levels in the morning before 9 a.m. The range can be anywhere between 300-1,000, but more is not better. I think optimal levels of testosterone should be between 400-600. If the first test is low, be sure to repeat it. We should never treat or diagnose low T based on one test.
It's important to consult with an urologist. How do we diagnose this? We look at each man individually. We evaluate their history, changes in sexual function, low libido, infertility issues, changes in sleep pattern, muscle strength, bone density and weight gain and work on the best treatment path from there.
Before approaching testosterone replacement therapy, I also strongly believe men should look into natural ways to increase their testosterone. This begins and ends with losing weight as we already mentioned, but here are a few more methods to consider:
1. Limit alcohol intake: Even drinking moderate amounts of alcohol can cause testosterone levels to plummet.
2. Reduce stress: be mindful of factors in your life that create stress. Mental or physical stress can quickly depress your levels. The stress hormone cortisol suppresses the body's ability to make testosterone.
3. Cardio: High-intensity exercise can cut stress in half but don't overdo it. Injuries and fatigue are sure signs that your workout may lower testosterone.
4. Zinc: The mineral zinc is important for testosterone production. Look to protein-rich foods like meats and fish. If you decide to supplement zinc, stick to a dosage of less than 40mg per day.
5. Vitamin D: This is a big secret when it comes to healthy testosterone levels. Foods like shellfish, tuna, salmon, egg yolks, beans and others work great. You can also look into taking vitamin D supplements, 1,000-2,000 IU per day (that's what I personally do) and monitor your levels after that. Vitamin D levels should be between 30-60.
6. Limit Sugar: When in doubt, say no to sugar. Testosterone levels decrease because sugar leads to a high insulin level.
7. Healthy fats: Foods like olive oil, raw nuts, coconut oil, grass-fed meats and avocados are essential for building testosterone -- 50-70 percent of your diet should include healthy fats.