Disappointments With Testosterone

For 80 (!) years physicians have prescribed testosterone to men without being certain if it actually had any effect other than raising testosterone levels. The only FDA-approved indication for testosterone is pathological hypogonadism, in which there’s an actual disorder of the male reproductive system that results in the body not producing enough testosterone. Examples are testicular damage from mumps, a genetic condition called Klinefelter syndrome, or problems with the pituitary gland, your body’s master gland.

Just as a woman’s sex hormones, estrogen and progesterone, decline with age, so goes a man’s testosterone. A woman might experience hot flashes, night sweats, disturbed sleep, and brain fog as result of diminishing sex hormones. Whether the mental fogginess is caused by low estrogen or by chronically interrupted sleep is uncertain. But menopause can be very uncomfortable.

For a man it’s different. Symptoms of declining testosterone are vague and may be unrelated to testosterone, indistinguishable from just getting older. The word “andropause” (intended to imply male menopause) has the ring of a Big Pharma neologism created to induce anxiety in aging male Baby Boomers who are feeling less than booming, but who are reluctant to confront the inevitable passage of time.

Driven by Adam Smith’s laws of supply and demand, doctors around the world (myself included) measured testosterone levels and, crackerjack scientists that we are, concluded that by merely raising testosterone from a pathetic low to a punchy high we could beat time at its game and reverse aging.

“Low T”
A lot of women, especially those on hormones themselves, liked this construct. The guy in your life exhausted and grumpy when he comes home from work? Looking a bit flabby? No longer the sexual stallion you married? Maybe you, too, egged on by Big Pharma’s commercials, thought, “I wonder if he has low T”?

“Low T.” As damning as Hester Prynne’s Scarlet A. “Honey, when you go in for your check-up, ask the doctor about your testosterone.”

Everyone, doctors and patients alike, took a major leap of faith by equating “High T” with a better life. Smelling the proverbial meat a-cookin,’ Big Pharma poured tens of millions into TV ads and visiting drug reps. Ever see those Charles Atlas ads on the back of comic books? Here’s what they looked like. Yes, Big Pharma was selling the promise of Mr. Atlas without all the hard work.

What muddied up everything was that every one of Big Pharma’s testosterone treatments raised a guy’s testosterone number. The before-and-after results were impressive. A guy could leave his doctor with a spring in his step because his once little-nothing-of-a-T now merited bragging rights at his bar, health club, board room, or hunting lodge.

But questions loomed large. Did men feel better with their new testosterone gains? And, was this a safe thing to do?

To a T
I’ll share with you a piece published in JAMA (Journal of the AMA) in 2017, reporting on two testosterone trials. Here’s a CNN overview as well.

In the first trial, researchers from several medical centers around the country recruited approximately 800 men over 65, all of whom had the dreaded Low-T for no apparent reason other than age. Half were given a testosterone-containing gel, the other half a placebo (the same gel, but without testosterone). They were retested periodically over the next 12 months.

First, to nobody’s surprise, everyone using the actual testosterone gel did show a measurable increase in T levels.

Sexual energy and function: men in the testosterone group seemed better during the first weeks of the study, but by the end of the study there was no difference between them and the placebo group. There was no explanation for this. I think the “You can’t fool Mother Nature” rule applies.

Cognitive function: there was no difference between the two groups in several tests of mental functioning.

Heart disease: the researchers began by taking baseline CT (computerized tomography) images of the coronary arteries in all men. One year later, there were no heart attacks in either group, but compared to the placebo group the T-taking men had narrower arteries and more plaque buildup (though not calcified plaque) than the placebo gel group. In the long run, non-calcified plaque leads to calcified plaque and this finding alone may be enough to warrant a death knell for testosterone.

Bone strength: there was improved bone density in the testosterone group, but not enough to warrant use of testosterone for male osteopenia (low bone mineral density), which is rare in itself.

Blood count: there was a mild increase in hemoglobin (red blood cell) levels of the testosterone group. This is a known effect of testosterone, but again not clinically useful.

The conclusion is simply this: as a man ages, his testosterone slowly falls, but without the overt misery many women experience with their drop in estrogen. The alleged benefits of using testosterone to increase your numbers from low to high are little more than smoke and mirrors, and with the changes in coronary arteries quite possibly dangerous.

Interestingly, there’s an herbal blend that stimulates the body to make more of its own testosterone. Testosterone Formula contains vitamins, minerals, and herbs that support and maintain healthy T levels. While there have been no clinical trials on this product, there’s an important difference in action between pharmacologic T and this supplement. The herbs it contains are three adaptogens (ginseng the best known), which work by helping the body adapt to stress and function optimally. When you take Testosterone Formula, everything involved in the body’s manufacture of testosterone functions more efficiently and, as a result, in many people there’s a slight rise in T levels.

Using adaptogens to improve natural function is, by the way, the exact opposite of what prescription testosterone gel will do. The high level of testosterone created by the gel will literally turn off a man’s ability to make his own T.

The most significant steps a man can take to slow down aging are related to lifestyle. He needs to exercise regularly, maintain a healthy weight, eat a nutritious whole-foods diet, remain mentally active, avoid tobacco, and get regular check-ups to make sure he’s not developing silent killers like diabetes or high blood pressure.

And remember, even Charles Atlas finally died.

Be well,
David Edelberg, MD

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2 comments on “Disappointments With Testosterone
  1. Gracen Smith says:

    Thank you! Dr.Edelberg! I haven’t heard a doctor speak the truth in so long that I have given up listening to them.
    -GSmith

  2. John Doe says:

    As someone who has taken hormone therapy (injectable testosterone) in the past, I can tell you that there is absolutely no substitute. An herbal supplement may bring you up ~100pts in combination with strict diet and heavy weightlifting, but if you’re seriously low (200s or below) the only way to go up to the 800-1000s range is through IT… and the differences are dramatic. The increases in libido, muscular endurance, and overall increase in well-being cannot be understated.

    That said, there are costs to every benefit. I have no doubt that it did put stress on my vascular system (my BP went way up) and immune system (many of us visit WHC for chronic conditions – steroids are basically poison when you have these). I have no doubt however that for many people, the quality of life experienced at higher-end T levels for the next 30 years is preferable to a 40 year span at low T levels. To each their own there.

    My problem with this post is the way it is presented. Is Testosterone over-prescribed to middle aged guys who just want to be on low-dose steroids? Absolutely – go to Tavern On Rush on a Saturday night or hang out at the East Bank Club pool and that becomes abundantly clear. But for you to write essentially a shill article for some herbal supplement sold in-house is more reminiscent of Dr. Oz than the man at the helm of the practice many of us look at to pioneer our own health journeys.

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