Testosterone has a bad name because of steroid scandals in baseball, cycling, track and field, and football. Scary tales promoted by the media and some segments of the medical community link testosterone to deadly heart attacks, cancer, liver disease and psychotic behavior. Consequently, many physicians are gun-shy about prescribing it to their patients.
Before age 60, men have more heart disease than women. Many scientists reasoned that since men have much higher levels of testosterone than women, the hormone must be linked to heart attacks. Well, think again. New research shows just the opposite. Low levels of testosterone (Low T) increases the risk of heart disease and is linked to type 2 diabetes, decreased muscle and bone mass, prostate cancer and depression. Low T impairs metabolic health, promotes obesity and decreases sexual performance. It is a serious public health issue that robs men of their energy levels and quality of life.
Harvard University urologist Abraham Morgentaler, MD hopes to change public perception about the dangers of low T and the beneficial effects of testosterone therapy for aging men. He used his 30 years of research and clinical experience to present a convincing argument for actively treating men with low testosterone levels.
Dr. Morgentaler commented on his clinical experience in an interview with FitnessRx: “I continue to be amazed at the ways in which testosterone therapy can absolutely change a man’s life. Most men I see come in for a specific issue, such as problems with erections or reduced sex drive. While testosterone therapy can be extremely helpful for these symptoms, its most important benefit is the feeling of being recharged again— feeling more focused, more vigorous, more masculine, more alive.”
Testosterone, Sexual Performance and Lifestyle
Testosterone levels decline in men after about age 35. The age-related decrease in testosterone is called andropause (“male menopause“), which is linked to muscle atrophy, psychological depression, declining sexual performance and reduced interest in sex. Increasing T levels boost sexual prowess, muscle mass and self-image.
Testosterone has important effects on sex drive and sexual performance. The hormone contributes to sperm cell production and semen volume, sex drive and the capacity for erections. Low T decreases sex drive and makes it more difficult to get and maintain erections. Sexual problems related to low T levels can begin as early as the mid-20s.
Many experts say that there is no “male menopause” because testosterone levels remain within normal values in most men — even in old age. Biologically available testosterone levels clearly decline during middle- and old age. In adolescents, small changes in testosterone result in obvious changes in physical performance and sex drive. Middle-aged men often experience a 50 percent decline in the biologically active free testosterone between ages 30-60. They can expect declines in sexual and physical capacities, even though total testosterone remains within normal limits.
Adequate is not the same as optimal. Middle-aged and older men are no longer content to sit in their rocking chairs watching the sun go down. They want to hike, ski, lift weights, play tennis, and have hot, vigorous sex. Active people want to perform at high levels in the bedroom or in the gym and feel great right up to the end! Dr. Morgentaler believes that treating men with low T levels improves quality of life, boosts sexual performance, prevents degenerative diseases and puts spark back in their lives.
Only about 8 percent of men with low T levels (total testosterone less than 400 ng/dL; free testosterone less than 15 pg/mL) are ever diagnosed and even fewer get treatment. Often, their physicians tell them to accept declining sex drive and energy levels, lost strength, depression and fatigue as natural parts of aging. Low T is a highly treatable medical condition. T therapy can turn the lights back on and make men feel better, improve their relationships, boost mental and physical health, and might even prolong life. Eyesight declines with age, but doctors don’t tell their patients to accept it and not wear glasses. They should deal with testosterone deficiencies in the same way they would diabetes or thyroid disease.
Many physicians won’t prescribe testosterone to aging men because they fear it might promote prostate cancer— the second-leading cancer-related cause of death in men. Studies from Harvard University, led by Dr. Morgentaler, showed that low T levels actually increased the risk of prostate cancer. T therapy only promoted the disease in men who had been castrated. Dr. Morgentaler noted, “There is not a single study that found any difference whatsoever in cancer outcomes for men with T concentrations of 200, 500, or 800 ng/dL.”
Physicians should suspect low testosterone levels if their male patients have decreased sex drive, erection problems, chronic fatigue, depression, increased abdominal fat, and loss of muscle mass and strength. Dr. Morgentaler’s advice to men with these symptoms included:
• Get a thorough physical examination that includes measurements of total and free testosterone. As discussed, men with total testosterone less than 400 ng/dL or free testosterone less than 15 pg/mL might benefit from testosterone therapy. Other important baseline tests include luteinizing hormone (LH), prolactin, hematocrit, hemoglobin, prostate-specific antigen (PSA), and bone density.
• T therapy is for men with low testosterone levels and should not be used in high doses to increase athletic performance. Dr. Morgentaler said, “The media often confuses testosterone use in athletes with legitimate medical use in men with low T. Sensational side effects, such as ‘roid rage,’ sometimes occur in athletes who take very large doses of the drug. Men taking clinical doses of T do not have these problems and seldom have side effects.”
• Take the testosterone supplement that works best for you. Options for T therapy include injections, patches, gels, compounded testosterone creams, buccal tablets (under the tongue), pills and testosterone-boosting drugs. Each has benefits and limitations. Bi-weekly injections (200mg testosterone enanthate or cipionate) are easiest but cause large “peaks and valleys” in testosterone levels (high T levels after injection and low T levels before the next injection). Patches are convenient, but can cause skin irritation in about 40 percent of men and can be embarrassing in the locker room or with a new bed partner. Gels produce more consistent T levels, but must be applied several times a day and often don’t produce high enough blood levels of the hormone. Compounded T creams are usually more concentrated but have not been evaluated by the Food and Drug Administration and are not recommended. Pills are toxic to the liver and are also not recommended. Drugs such as clomiphene and anastrozol stimulate the body to produce testosterone and are a good choice for men wanting to father children. However, these drugs usually don’t produce optimal blood levels of testosterone.
• Lose weight. Excess body fat lowers testosterone by increasing levels of steroid hormone-binding globulin (which reduces the biologically active free testosterone) and increasing the conversion of testosterone to estrogen by a process called aromatization. Increased estrogen levels in overweight men cause breast development (gynecomastia).
• Monitor side effects: Any drug can potentially cause side effects and the ideal drug dose varies with the individual. Your physician will probably want to monitor total and free testosterone, hematocrit (percent of blood composed of cells), hemoglobin (oxygen carrier), PSA (prostate test), HDL (good cholesterol) and blood pressure. Monitor measures of fertility (i.e., sperm count), if you want to conceive.
Exercise, Diet and Testosterone
Physical inactivity and poor diet promote obesity and create poor metabolic health that disrupt sensitive hormone systems that process carbohydrates, fats and protein; and regulate signaling chemicals that build bone and muscle mass. Moderate-intensity aerobic exercise, weight training, weight management and stress reduction contribute to healthy anabolic hormone regulation (i.e., testosterone, growth hormone, IGF-1) that give you energy, help make you a lion in the bedroom and contribute to a general joi de vivre.
Good diet and exercise promote testosterone production, improve androgen receptor activity and enhance metabolic health. While improved lifestyle cannot compensate for extremely low levels of testosterone, it will help you get the most from what you have and make your body’s metabolism work better. Dr. Morgentaler commented, “While exercise and diet can influence testosterone levels, it is doubtful that lifestyle changes alone will compensate for extremely low levels. I urge my patients to exercise and eat healthy diets, because it makes them feel better and enhances overall health.”
Exercise and diet should be part of the overall testosterone management program, particularly in older competitive athletes who are not allowed to take testosterone supplements— even when they are medically prescribed. Several years ago, a masters shot-putter from England filed a medical exemption waiver to use testosterone with the International Association of Athletics Federation (IAAF, the international ruling body for track and field). The athlete had a low testosterone level that was contributing to his diabetes. The IAAF ignored his request, tested him at the Masters World Championships in Spain and gave him a two-year suspension for using testosterone.
Basic principles for maximizing testosterone levels naturally include:
• Do at least 30 minutes of moderate-intensity exercise every day. Regular exercise contributes to metabolic health, which optimizes blood flow control in the penis, increases testosterone and gives you the energy and libido for good sex. The time you exercise depends on your needs and goals: exercise longer if you need to lose body fat or improve aerobic fitness and less to emphasize weight training or have limited time.
• Lift weights: Weight training boosts testosterone, increases testosterone receptor density (so the hormone works better), helps control abdominal fat, increases muscle mass and enhances self confidence— all critical for maximizing testosterone levels and its effectiveness. Also, higher testosterone levels increase the capacity to gain muscle mass and strength. Multiple-set workouts using short rest periods increase testosterone best. However, overtraining suppresses androgen receptor activity, which makes training less effective. Train hard, but not too hard.
• Eat a healthy diet: A good diet promotes metabolic health, prevents free radical damage (a kind of biological rust) that impairs sexual function and gives you the energy you need to be a dynamo in the bedroom. Diet and testosterone will be discussed separately in this article.
• Lose weight: Increased body fat, particularly if carried in the abdomen, decreases testosterone levels, makes you less desirable to women and promotes erection problems. Burning more calories than you consume, through a sensible program of exercise and diet, reduces abdominal fat and beefs up blood testosterone levels. In turn, higher testosterone levels help you manage body fat and improve your sex life.
• Don’t overtrain: Balance training and recovery, because excessive exercise depresses testosterone and impairs sexual and physical performance.
• Get enough sleep and minimize harmful stress: Excessive stress and lack of sleep depresses testosterone, increases cortisol (a catabolic stress hormone) and lowers libido. Learn to distinguish good stress from bad. Good stress makes you grow emotionally and physically and perform at top levels. Bad stress grinds you down and impairs the immune system. Don’t sweat the small stuff!
• Think like a winner: Mental state has a profound effect on testosterone levels and sexual performance. Testosterone levels go up after winning an athletic contest, but go down after a loss. Assertive behavior followed by a rise in status leads to an increase in testosterone levels. Developing a winning mental attitude sets you up for success in life and boosts testosterone levels.
• Stay sexually active: Frequent good sex increases testosterone and improves metabolic health, which leads to more and better sex. The best advice for maintaining sexual health is to practice, practice, practice!
• See your doctor: Medical problems, such as diabetes and aging, can lower testosterone levels. Training and diet may not be enough, so get checked out to rule out health problems. Many aging men, even those in their 30s, can benefit from hormone supplements. Testosterone supplements may be just what the doctor ordered to rejuvenate and energize your life.
Testosterone plays a critical part in your everyday health, mental and physical well-being. Whether you are looking to lose weight, burn fat, gain muscle, boot energy or have better sex, your natural testosterone level or lack of, can limit your desired results. Even men in their mid-20’s can experience lower than desirable testosterone levels. It is important to have your levels checked to ensure that you’re testosterone levels are in normal range to give you the results you are looking for.
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