This month, in honor of Men’s Health Month, let’s talk about testosterone supplementation in the aging male. Testosterone (T) is the primary male sex hormone. It makes boys into men, and some believe it is the key to the fountain of youth.
There are both benefits and risks to testosterone replacement therapy (TRT) as we age. You may have seen some of the many direct-to-consumer advertisements touting the benefits of “fixing low T.” The promise of increased vitality, energy, strength and sex drive has driven a rise in demand for TRT as well as an escalation in prescriptions.
Generally, T levels peak in men by 20 years of age and start to decline in midlife by 1 percent per year. T is responsible for a man’s muscle mass, fat distribution, mood, sex drive, bone density, and red blood cell and sperm production.
Waning T levels may result in sexual dysfunction, a decrease in lean muscle mass and strength, decreased bone density, and a lack of energy or even depression. These symptoms can be improved by optimizing T levels and may elevate your mood, energy level and ability to concentrate. These are solid facts, but is supplementation a safe practice?
Supplementing testosterone is not without its drawbacks. There is a risk of cardiovascular events (heart attack or stroke), as well as blood clots from elevated red blood cells. It may lead to the development or acceleration of prostate or breast cancer. Acne, hair loss, enlarged male breasts and a worsening of sleep apnea can also occur.
The FDA has approved testosterone replacement for hypogonadism (low testosterone and/or sperm production). It is not approved for late onset hypogonadism but often prescribed as an off-label use.
A medical history and physical can help identify your personal risks and benefits of TRT. For example, it would not be beneficial to take TRT for erectile dysfunction (ED) if the ED is due to cardiovascular disease. Many commonly prescribed medications can lower testosterone levels as well.
Following a healthy lifestyle may be all that is needed to improve your testosterone levels. This can lower your risk for diabetes, which contributes to low T. Maintain or achieve your ideal body weight. The more fat cells present, the more testosterone will be converted to estrogen (the main female hormone).
Exercise, eat healthy food, get adequate sleep, reduce stress, do not smoke, limit alcohol intake and the use of opioids. Avoid use of certain plastics that contain bisphenol A (BPA) or phthalates, as well as the use or consumption of pesticides or herbicides that contain organophosphates. Ask your physician about supplementation with zinc, grape seed extract, quercetin, and DHEA (a precursor to testosterone) to improve your T levels.
Could declining T levels with age be an evolutionary adaptation as a way of prolonging life? Perhaps the notion of a fountain of youth is more than fantasy.
Dr. Michal Kazimir is an internal medicine physician and hospitalist at Lutheran Medical Center.