Testosterone and sex
The commercials insinuate you have low testosterone, or “Low T.” You’re quickly assured that you need not worry, for Low T now has a simple remedy. Just apply a daily dose of topical gel and restore your youthful vitality and virility.
If it were only that simple.
Decreased libido, energy, and testosterone levels are common in aging men, but is it always reasonable to treat these symptoms with testosterone supplements?
Many possible causes
Fatigue and a listless libido may have multiple causes. So first off, make an appointment with your doctor, and do include a conversation about any medications you’re currently taking. Catherine Sarkisian, MD, MSPH, of the Geriatrics Division at UCLA, counsels patients to “be sure your fatigue is not being caused by other medications, since fatigue is a common side effect of many prescription drugs.”
Furthermore, low testosterone levels may not mean abnormally or dangerously low levels that call for medical treatment. This is especially true if low testosterone is not accompanied by symptoms.
And certainly, the rapid-fire list of possible side effects that conclude the television ads indicate that taking a testosterone supplement is not without possible dangers.
Risks vs benefits
While the drug companies would like men to diagnose themselves as suffering from Low T and pressure their doctors to prescribe testosterone supplements, is this wise? While men naturally want to maintain as much youthful vigor as possible, are testosterone supplements the best and safest way to stay young? Who would benefit from testosterone supplements?
The physicians at the Pritikin Longevity Center in Miami, Florida, recommend that only men who consistently tested with low testosterone levels and have the associated symptoms of decreased energy, muscle strength, libido, and general well-being be considered for hormone replacement therapy.
“Also, men should be counseled that the T.V. commercials they’ve seen on testosterone therapies have likely amplified the therapies’ benefits,” notes Ronald Scheib, MD, FACC, cardiologist and educator at Pritikin.
Researchers, for example, recently studied 237 men ages 60 to 80 with low testosterone levels and found that those who received testosterone supplementation did not fare any better in terms of muscle strength, functional mobility, cognitive ability, and overall life satisfaction compared with those taking a placebo.1
And in an analysis of 17 trials that involved in total 862 men with sexual dysfunction, testosterone use was associated with only “small improvements in satisfaction with erectile function and moderate improvements in libido,” but “no significant effect on overall sexual satisfaction.”2 Moreover, the scientists cautioned that their inferences were weakened because of unexplained inconsistent results across the trials and possible reporting biases.
As stated earlier, decisions about taking testosterone involve not only a discussion of benefits but also one of possible negative side effects.
Taking testosterone may raise hemoglobin or red blood cell counts to levels that increase the likelihood of clotting and the possibility of stroke. In 2014, the FDA, echoing these health concerns, called for labels on testosterone supplements that warn of blood clots.3
Pritikin cardiologist Dr. Ron Scheib adds that some research suggests that testosterone supplements may increase the likelihood of heart attacks and other cardiovascular-related adverse effects.4 But, he points out, “We don’t have the long-term randomized, controlled studies to provide solid evidence.
“And it is likely the Internet and other media have overblown the risks.”
No danger, but no benefit
Indeed, a three-year study5 published in 2015 that assessed the safety of testosterone treatment did not find that men using testosterone gel suffered any additional damage to their coronary arteries compared with men using a placebo gel.
That said, the men rubbing the testosterone gel on their bodies every day did not see any changes in their sex lives, either. Their levels of sexual desire, erectile function, and overall sexual function were pretty much the same as the men in the placebo group.
All 308 men in the study were 60 or older, and all had testosterone levels in the low or low-normal range, typical of men in this age group. Now, if the study had been conducted on men with lower ranges of testosterone levels, the results might have been different. Possibly, these men might have received benefits in sexual function.
Earlier this year, a group of international experts developed and published6 a set of conclusions to attempt to provide clarity for physicians and patients on testosterone deficiency and therapy.
“It was important to set aside the various distortions and misinformation that have appeared regarding testosterone therapy and to establish what is scientifically true based on the best available evidence,” said Abraham Morgentaler, MD, chairman of the consensus conference. Dr. Morgentaler is the Director of Men’s Health Boston and an Associate Clinical Professor of Urology at Beth Israel Deaconess Medical Center and Harvard Medical School.
Dr. Morgentaler and colleagues — who included experts with specialties in urology, endocrinology, diabetes, internal medicine, and basic science research — unanimously agreed on many issues, including the following:
- Testosterone deficiency is a well-established, clinically significant medical condition that negatively affects male sexuality, reproduction, general health and quality of life.
- Symptoms and signs of testosterone deficiency occur as a result of low levels of testosterone and may benefit from treatment regardless of whether there is an identified underlying origin.
- Testosterone therapy for men with testosterone deficiency is effective, rational, and evidence-based.
- There is no testosterone concentration threshold that reliably distinguishes those who will respond to treatment from those who will not.
- There is no scientific basis for any age-specific recommendations against the use of testosterone therapy in adult males.
- The evidence does not support increased risks of cardiovascular events with testosterone therapy.
- The evidence does not support increased risk of prostate cancer with testosterone therapy.
- The evidence supports a major research initiative to explore possible benefits of testosterone therapy for cardiometabolic disease, including diabetes.
Small, short-term research does suggest the possibility that testosterone supplements might improve insulin sensitivity in men with type 2 diabetes and/or the metabolic syndrome.7
The T Trial
But when all is said and done, there’s still so much we don’t know about testosterone therapy. Scientists are awaiting the results of the “The T Trial,” a large, randomized study now being conducted by the National Institutes of Health to more definitively determine if supplements benefit older men with low testosterone.
First, discuss with your doctor any of the symptoms that might be related to Low T and get your testosterone levels tested.
Next, with your doctor, consider other possible causes and treatments for your symptoms.
And by all means, embrace lifestyle approaches, like the Pritikin Program, that have multiple proven health benefits, and no risk.
Studies do show that men who are obese or overweight have lower testosterone levels. So the weight loss that comes from following the Pritikin lifestyle guidelines may increase testosterone levels and improve symptoms.
“The optimal treatment for a low libido may well be a healthy lifestyle, not testosterone,” states Dr. Danine Fruge, MD, Medical Director at the Pritikin Longevity Center.
“Many men can markedly improve sexual function with diet and exercise. We see it – rather, we hear about it – all the time here at Pritikin,” smiles Dr. Fruge.
So exercise daily. Eat a tremendously healthy diet like Pritikin. Take good care of your psychological health. “You’ll shed body fat, lower your blood pressure, ratchet down your cholesterol levels, and with all these health variables improving, there’s a very good chance your libido will improve, too,” sums up Dr. Fruge.
- 1 JAMA, 2008; 299: 39.
- 2 Mayo Clin. Proc, 2007: 82: 20.
- 3 http://www.fda.gov/drugs/drugsafety/ucm401746.htm
- 4 New England Journal of Medicine, 2010; 363: 109.
- 5 JAMA, 2015; 314 (6): 570.
- 6 Mayo Clinic Proceedings, 2016; 91 (7): 881.
- 7 Diabetes Care, 2011; 34: 828.