Men, you’ve probably seen the commercials. You know - the ones with well-known, aging, former pro athletes pushing the “latest and greatest” testosterone booster with claims about how it’s helped them overcome low testosterone, or “low T” as they call it, and regain the energy, muscle mass and even the sexual drive and performance of their past. Maybe you’ve sat in front of the TV and yearned to regain some of your own long-lost vitality. It’s only natural to be interested in what your old heroes have to say about it and to be intrigued by their claims.
But low testosterone, also known as hypogonadism, isn’t just some symptom of getting older that you can easily reverse with the help of the newest over-the-counter miracle supplement. It’s a real medical condition that impacts an estimated 35 percent of men over the age of 45, according to the Endocrine Society. It can have a real impact on your health or signal numerous other problems. And for that matter, its treatment may not be quite as simple as those commercials might lead you to believe.
Symptoms of Low Testosterone
Testosterone is a male sex hormone produced in the testicles that is important to male development and functions. The American Urology Association defines low testosterone in the blood as less than 300 nanograms per deciliter (ng/dl). The most commonly associated symptoms, especially in men above 45 years of age include:
Reduced lean muscle mass
Loss of body hair
However, according to Bryan Grove, MD, with The Christ Hospital Physicians – Primary Care, it can present less-obvious symptoms that you should watch for as a potential sign of low testosterone. “Sometimes, low testosterone can cause mental health concerns such as memory issues or even a depressed state,” he says. “These are most common in men over the age of 50 but can happen at other ages, as well.”
As a family medicine specialist, Dr. Grove treats patients of all ages, so he works with patients who come to him with a variety of age-specific symptoms for low-testosterone. “For men between 20 and 50, there can be issues with infertility,” he says. “But that’s usually not a known issue until there is trouble with having children.”
For males under the age of 20, Dr. Grove says the most common issues are delays in puberty and the associated physical developments. Some males this age, and even older, experience gynecomastia, an enlargement or overdevelopment of breast tissue in men or boys.
Associated Health Risks of Low Testosterone
Age aside, testosterone levels can be impacted by numerous factors such as hormone disorders, testicular injury, radiation or chemotherapy treatments for cancer, excessive alcohol use, and certain medications such as opiate painkillers, steroids, and blood pressure medications. Certain genetic conditions can also impact levels.
Low testosterone can also be linked to other health concerns, even in younger men. Chronic liver and kidney disease, obesity, sleep disorders, type 2 diabetes, and HIV/AIDS, for example, can cause a significant drop in testosterone level.
Dr. Grove says obesity can be especially tricky when it comes to regulating testosterone levels.
“Obesity is known to cause the body to convert testosterone to the female hormone estrogen,” he says. “Estrogen can cause you to gain weight, which, in turn, can cause more conversion to estrogen. It’s a viscous cycle and all the more reason to control your weight through lifestyle choices or talk to your doctor about sudden unexplained weight gain.”
Medical Treatment of Low Testosterone and the Risks
According to Dr. Grove, there are three main forms of medical testosterone therapy that doctors can prescribe, and each comes with its own advantages and disadvantages:
Oral: which Dr. Grove says he is least likely to prescribe, in spite of it being the easiest to administer. “There can be absorption issues which makes it the least reliable option for effective treatment,” he says.
Topical gels: which are the most user-friendly and can be very effective but can also be costly. “This option really comes down to what’s available to you through your insurance. If it’s covered, it’s often a good option, though there are some cases where it isn’t the most effective treatment for some men.”
Injectables: which Dr. Grove points out are both the most cost-effective option and are generally the most reliable option. “They can provide the most consistent levels of testosterone, although that could require adjusting frequency and dosage dependent on the individual patient,” he says. “And of course, there’s always the issue of a person’s willingness to have to deal with needles.”
No matter the format, Dr. Grove said it’s important for men with low testosterone and their doctors to consider the risks involved with testosterone therapy and to be watchful for signs of those risks. “Treatments are generally safe and effective,” he says. “But it’s not for everybody. and there are associated risks.”
You should not undergo testosterone therapy if you meet any of the following criteria:
A history of or suspected prostate or male breast cancer
Enlarged prostate or elevated prostate specific antigen (PSA) levels
High number of red blood cells
Untreated sleep apnea
Recent heart attack or stroke
Plans to have children
Potential risks for those receiving testosterone therapy include:
“Treatment is still safe, as long as it’s done in conjunction with regular care from your primary care provider or other prescribing physician,” Dr. Grove says. “We know what to watch for and can help you monitor for signs of troubles. We do regular blood draws to monitor not only your testosterone levels, but signs of issues associated with low testosterone and the treatment.”
Of course, as Dr. Grove points out, there’s always the opportunity to decrease your risk of low testosterone through a healthy lifestyle.
“If you work on your diet and exercise regularly, it will work tremendously on helping you to keep your testosterone at a healthier level,” he says. “Not to mention the myriad of health risks associated with obesity such as diabetes and heart disease, so it’s a win for you all around. Limiting alcohol intake can also decrease your risk.”
What About those Over-the-Counter Testosterone Boosters?
So, what about those over-the-counter boosters you may see advertised. Do they even work?
“That’s a big ‘maybe,” Dr. Grove says. “There are certainly a lot of supplements out there, and with the FDA not being involved, it can be like the wild wild west in trying to sort through them and find something that can help.”
He cites a recent study from The National Center for Biotechnology Information that evaluated the claims and information publicly provided by 50 leading “T boosting” supplements. The information included components found in these supplements.
Ninety percent of the supplements in the study claim to increase testosterone levels, but only about 25 percent of them had data to show the presence of components to support those claims. In fact, about ten percent of the supplements in the study have data showing the presence of components known to potentially reduce testosterone levels, and thirteen of the supplements exceeded the FDA’s tolerable upper intake level of ingredients such as zinc, vitamin B3, and magnesium.
“While certain ingredients are known to be associated with boosting testosterone levels, there’s simply not enough data to back up the claims of most of the leading “boosters,” Dr. Grove says. “Not to mention the impact of other factors and how well these supplements are absorbed. We have proven therapies that are often cheaper than these supplements when covered by insurance. So why spend your money on something with very little data to back up the claims?”
Where to Start? Talk to Your Doctor
Dr. Grove acknowledges that some men may still be intrigued by these products and urges them to bring them to their doctor if they really want to try them.
“Maybe we don’t have the answer then and there for that specific supplement, but we have your health in mind, so we can find out what you need to know and get that information to you.”
Concerns about low testosterone, potential treatments and associated health concerns are just the beginning about why it’s important for men to establish and maintain a regular primary care routine, especially as they get older.
“Primary care is crucially important when it comes to diagnosing and treating conditions such as low testosterone,” Dr. Grove says. “Think about the potential baggage involved – obesity, kidney and liver disease, diabetes and everything associated with it. Those alone should make you want to work with a doctor. If you’re concerned that you have low testosterone, what else could potentially be wrong? We can help you find out and work with you on taking care of your health. It’s a partnership. It’s why I do what I do.”
Click here if you need to schedule with your Christ Hospital primary care provider or if you need to find a provider. You can also call our referral line at 513-585-3000 to speak to a referral specialist if you need to find a provider and don’t know where to start.