It all began several years ago when Oprah said she was using some testosterone cream to improve her sex life, and that she ‘swears by it’….and the floodgates opened.
Testosterone is the ‘male’ hormone, as estrogen is the ‘female’ hormone. Men and woman have both of these hormones in their bodies, with women…99% is estrogen and in men 99% is testosterone. Still, there is a small amount of the opposite hormone in them as well, for a variety of reasons and with a variety of effects.
As women age, estrogen levels drop off at the time of menopause…but there is no equivalent dropping off of testosterone in men—there is no ‘male menopause’. Why that is, is not certain, but one presumes it relates to evolutionary effects on fertility and the fact that women cannot bare children at later and later ages without sustaining significant health risks; whereas men, with the smaller contribution to fertility and gestation, can maintain fertility into their later years without sustaining health risks.
Low testosterone levels, truly low levels, are manifested by lack of body hair, lack of any sex drive at all, and is characterized by extremely low levels of testosterone that are barely measurable. Such patients don’t complain about no sex drive…it’s their wives and girlfriends who do the complaining. Why is that? Because the men don’t know that they don’t have a sex drive and without hormone to stimulate their libido….they don’t care!
These men may have a particular health issue causing such low testosterone. Failure of the testes or the pituitary gland…or some other hormonal imbalance that causes this.
On the other hand, the more common ‘low T’ patients has levels that are just below the normal range, or at the low end of normal. They do not suffer greatly with symptoms, but can note a variety of milder variations in how they feel (see this quiz to get an idea of the various symptoms related to this.)
What to do about truly low T? We do a thorough evaluation by an endocrinologist and work-up for specific diseases, then supplementation with either topicals or injections (pills are not allowed as they bother the liver).
For the ‘borderline low T’ the patient will try a supplement as above, and we will observe for improvements in symptoms. Of course, there is a great deal of ‘placebo effect’ wherein the man may get a sense of well being just from knowing they are getting treated, but we try to monitor levels and see if there is truly a correlation between symptom relief and higher testostone levels. I must say that in my own experience, most of these men to do not feel a great deal of improvement. Some do…and for those, we continue on supplementation, but for those who do not feel any improvement, the supplements are stopped.
Nowadays, there a clinics opening up on the street corner talking about ‘fixing’ the low-T problem for men. I think one should be wary of this as there is a lot of unknowns both in the diagnosis and treatment of this borderline issue. Much of the concern, having been generated by Big Pharma, educating patients about testosterone and in the process attempting to create a market for their $300 per month treatments.
So….low T is a complicated subject. If you have questions about this we need to talk, do some bloodwork , and then talk again about the results and their implications, with an honest discussion of the value of trying to improve testosterone levels and a healthy amount of skepticism about the treatment regimens.