Like any other hormone deficiency (thyroid, insulin, estrogen-progesterone) deficient testosterone in men will interfere with a healthy and vigorous life. Natural, bio-identical testosterone is available but is often avoided because of misunderstandings and myths about the role of this vital hormone. Please see my other blog: Testosterone and anti-aging.

A lot of men do not realize why they are experiencing certain symptoms and signs as they age; why they seem to have gained weight even though they exercise, or why their breast are larger and flaccid.  Other symptoms can be depression, irritability, mood swings, loss of morning erections. erectile dysfunction, poor focus and concentration. loss of incentive both for work and for things that thy once enjoyed, loss of muscle tone and yes, some even experience night sweats. (See my blog on comparing menopause to andropause or my book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.

As men grow older we produce less testosterone. This actually begins to happen at the age of about 30-35, but in men it is a slow, subtle, process until about 50-60 years of age (unlike women who go through a more rapid menopause in 1-8 years).

Many people think of testosterone as a man’s hormone created to annoy women, but much academic work shows  the remarkable physiological role testosterone plays in our lives in both males and females. Obviously men have  much more testosterone then females. Because it is the main muscle and bone builder it is why men do not get osteoporosis until  much later than women – but we do get it. Evidence shows that there exists 3-4  times more testosterone receptors in the heart cells than in the gonads, showing that nature intends for testosterone to give the heart protection. Testosterone also helps to produce more nitric oxide, which, like synthetic nitroglycerin helps to expand the vessels and give better circulation.

There are also testosterone receptors in the brain. Using functional MRI (fMRI which shows what part of the brain is being used for a specific function) it has been shown that men (and women) with low testosterone levels were more ” foggy brained.” In fact, when the levels were real low the ability to fantasize was lost.  Other studies have shown that lower testosterone levels are a factor to increase the  likelihood of developing Alzheimer’s disease. A study of men with Alzheimer’s demonstrated that taking testosterone dramatically  slowed the progression of Alzheimer’s although it did not cure it. All these studies demonstrate that there are receptors for testosterone in the brain. (All these facts are documented as evidence based medicine in my book’s biography).

Studies have indicated that as much as 65%-70% of depression in men over 50 could be due to low testosterone levels, so there is often no need for antidepressants  and their possible side effects. I believe it is necessary to always check testosterone levels when a man has consistent depression.

Testing for testosterone is a simple blood test, but it’s important to get the right tests and interpret them properly.  One not only wants to know the total testosterone but also the amount getting into the cells (free testosterone).  Obviously if a hormone is not getting into the cells it is like not being there. Also, testosterone can bind to a protein called Sex Hormone Binding Protein (SHBG) ; so this test should be done if the physician believes this is one of the problems. If the testosterone levels seem good but the SHBG is high the testosterone is not going to perform its job since it is being tied – up.  A man’s estrogen level must be examined since testosterone can convert to estrogen  (aromatization)  through an enzyme called aromatase.  This enzyme is found in adipose tissue and as men get older they gain more fat (often because of the lack of testosterone). Also, other tests may be appropriate, but certainly a PSA (prostate specific antigen) is necessary. (See my blog or book on prostate evaluation).

Testosterone levels in the “low Normal” range can be misleading (400ng-1000ng).  For a real low level the physician may say they are in the norm. They may be normal for an eighty year old, but the signs and  symptoms presented by an eighty year old are not particularly desirable.

The belief that testosterone causes cancer is a myth and of the old school.  If it were true then men at twenty when testosterone levels are the highest would be more prone to prostate cancer or have signs of future development of the cancer.  It is now known that it is estrogen that contributes to prostate cancer (the same hormone that contributes to breast and uterine cancer in women) along with life style. This is  because inside the prostate is a vestige of the uterus called a utricle  that has estrogen receptors. To simplify, all fetuses begin as female but may change to male due to genetics but this vestige gets locked inside the prostate. If the utricle is constantly hit by estrogen excess cancer may occur. Statistically overweight men have a higher rate of prostate cancer, probably aromatization contributes to this.

There are several ways to take testosterone, one should always and only use bio-identical hormones. These are made by a compounding pharmacist (not a big chain pharmacy) and are made specifically for the individual since each person is different then another. The two ways I prefer are creams that are absorbed through the skin, and tiny pellets that are inserted into the buttocks and  last for about  5-6 months. I do not use  oral testosterone since the levels fluctuate too much and they can be harmful to the liver as can injectable testosterones. I must repeat her that I only believe in bio-identical hormones since this is what nature has put into our bodies.

So one does have to get older but one does not have to age. It is not only longevity but also quality of life.

I have written out all tests for both males and females that are necessary for hormone testing in the appendices of my book along with many other helpful charts pertaining to hormones. The book and charts will help you have intelligent discussions with your physician. Also this subject is expanded in layman’s terms for a more didactic but easily understood education.

Alan J. Sault MD, ABHM-Diplomat

Author: Emotional Vampires and Your Hormones: an holistic physician’s view of  how stress affects your well – being and what  you can do about it.

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