Adapted from Labrix Clinical Services, Inc

As with women’s hormones, there are many misconceptions and myths when it comes to men’s hormones. Women have an obvious marker of hormone decline when their menstrual cycles begin to change and eventually stop all together. For men, the changes in their hormones are often more subtle and less specific, leaving room for confusion, misdiagnosis and lack of treatment. Though not a myth, the first misconception about men’s hormones is the lack of understanding of the symptoms of testosterone decline and the incredible prevalence with which it happens. Studies indicate that nearly 40% of men over the age of 45 have overtly low testosterone levels. Recent pharmaceutical advertising campaigns have brought this subject some much needed attention, although there are still many common misconceptions when it comes to testosterone and men’s health.

Myth #1: The primary symptom of low testosterone is erectile dysfunction or low libido.
FALSE: Though low or suboptimal testosterone levels can contribute to changes in libido and the ability to achieve or maintain an erection, symptoms are varied and often include fatigue, apathy, difficulty concentrating, weight gain, depression, sleep disturbances and, most importantly, changes in metabolism including an increased risk for metabolic and cardiovascular disease.

Myth #2: Testosterone replacement increases risk of adverse cardiovascular events.
FALSE: There were two articles published at the end of 2013 and in the early part of 2014 which purported that men on testosterone supplementation had an increased risk of heart attack, however neither of these studies was particularly well run. They were both observational and retrospective, which severely limits the ability to control variables and is not sufficient to establish causation. Furthermore, one of the studies found that the mean level of men who were ON SUPPLEMENTATION was still only 332 ng/dL, and nearly 40% of the cases didn’t even have post therapy levels measured. While there is no agreed upon “low” for serum testosterone levels, most labs have a reference range that goes from approximately 300-1100 ng/dL, so a measurement of 332 is quite low. Conversely there exists a multitude of studies that link LOW testosterone to increased cardiovascular disease, and furthermore that testosterone replacement improves cardiovascular and metabolic markers. The NIH conducted one of these studies for the express purpose of investigating the findings of the JAMA study that linked testosterone replacement to increased risk. This follow up study looked at over 24,000 patients and found no increased risk of heart attack in those treated with testosterone.

Myth #3: Men should only be treated with testosterone if their measured levels are overtly low.
FALSE: As is typical with laboratory medicine, the reference range parameters don’t always equate with the optimal clinical outcomes. Studies indicate that men who maintain their testosterone levels in the mid to upper range have reduced incidence of cardiovascular events compared with those in the overtly low, or high ranges. The threshold of benefit appears to be greatest when levels are maintained above 500 ng/dL in serum. Note: because transdermal supplementation is not accurately reflected in serum levels, the target for patients using creams or gels should be the mid to upper reference range in saliva.

Myth #4: Testosterone supplementation causes or contributes to prostate cancer.
FALSE: In the 1940s it was observed that castration reduced the incidence of prostate cancer. From this observation, it was extrapolated that testosterone must play a role in the pathophysiology of prostate cancer. The testicle produces several hormones other than testosterone, and it is now believed that the improvement seen in those patients was due to a decrease in estrogen production rather than testosterone. Prostate cancer is uncommon in young men, who generally have higher levels of testosterone, and becomes more prevalent with age, as testosterone levels fall. Over the past decade or so, there have been many investigations that have disproven the link between testosterone and prostate cancer. ,

Myth #5: The only way to increase testosterone levels is with hormone replacement.
FALSE: Though testosterone replacement can be a very powerful and effective treatment, there are many natural ways to boost endogenous testosterone production. For many men, weight loss will go a long way to boost testosterone levels. This is further improved with the building of muscle mass, therefore weight or resistance training is highly recommended. Short term, moderate intensity endurance training can also significantly increase testosterone levels. There are several nutritional and herbal supplements that improve testosterone levels including zinc, Tribulus terrestris, and Epimedium grandiflorum. Additionally, supplementation with DHEA, a hormonal precursor to testosterone can be effective in many cases.

Are you or the men in your life showing signs and symptoms of low testosterone? Schedule an appointment with Dr. Robyn for an evaluation of your testosterone levels and to discuss what treatment options are right for you.

References:

Mulligan T et al. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60:762-9.

Oskui P, French W, Herring M, et al. Testosterone and the Cardiovascular System: A Comprehensive Review of the Clinical Literature. J Am Heart Assoc. 2013 Dec; 2(6): e000272.

Baillargeon J, Urban RJ, Kuo YF et al. Risk of myocardial infarction in older men receiving testosterone therapy. Ann Pharmacother. 2014 Jul 2;48(9):1138-1144.

Kelly DM, Jones TH. Testosterone and cardiovascular risk in men. Front Horm Res. 2014;43:1-20.

Aversa A, Bruzziches R, Francomano D et al. Effects of testosterone undecanoate on cardiovascular risk factors and atherosclerosis in middle-aged men with late-onset hypogonadism and metabolic syndrome; results from a 24-month, randomized double-blind, placebo-controlled study. J Sex Med. 2010 Oct;7(10):3495-503.

Huggins C, Stevens RE, Hodges CV. Studies on prostate cancer: II. The effects of castration on advanced carcinoma of the prostate gland. Arch Surg. 1941;43(2):209-223.

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Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004 Jan 29;350(5):482-92.

Endurance training of moderate intensity increases testosterone concentration in young, healthy men. Int J Sports Med. 2009 Jul;30(7):489-95. Epub 2009 Mar 19.

Om A, Chung K. Dietary zinc deficiency alters 5 alpha-reduction and aromatization of testosterone and androgen and estrogen in rat liver. J Nutrition. 1996; 126: 842-48.

Zarkova S. [Steroid saponins of Tribulus terrestris L. have a stimulant effect on the sexual function]. Rev Port Ciencias Vet 1984;79(470):117-126.

Kuang AK, et al. Effects of yang-restoring herb medicines on the levels of plasma corticosterone, testosterone and triiodothyronine. Zhong Xi Yi Jie He Za Zhi. 1989; 9: 737-8, 710.

Genazzani AR, et al. Long-term low-dose dehydroepiandrosterone replacement therapy in aging males with partial androgen deficiency. Aging Male. 2004; 7: 133-43.