It seems that every time we turn on the TV or open a magazine there is a new ad for a testosterone replacement therapy to treat what pharmaceutical marketers like to call "Male Menopause" or "Andropause". Despite being a physician who treats low testosterone every day, every time that I see one of these ads I get downright irritated.

What irritates me is that low testosterone as experienced by most men today is not a "normal part of aging" like menopause in women. Over the past 70 years modernized people have seen a steady decline in average testosterone levels among all age groups... this phenomenon appears to be a new disease of the industrialized world. The average American today over 40 has a testosterone level roughly half the level men had 70 years ago.

When researchers look at the available historical data, they see that testosterone levels (first measured and tracked broadly in the 1940s) declined only slightly over a lifetime, and most men had testosterone levels that were completely adequate into their 70s and 80s. An average man in the 1940s died with higher testosterone levels than an average man in his 50s has today! The scary part is that levels are still declining; how low they might go in future generations is anyone’s guess.

Most researchers examining the mystery of declining testosterone levels believe that certain chemical toxins that we all are exposed to throughout our lives are to blame. Some of these toxins can actually increase the activity of an enzyme – aromatase, which can convert a man’s testosterone into estrogen. Other toxins are known to directly stimulate estrogen receptors. It has been hypothesized that these chemicals may be acting directly on the hypothalamus (the part of man’s brain that regulates levels of testosterone) to inhibit the release of LH and FSH, two hormones that stimulate the testicles to produce testosterone.

Why is all this important? Many patients and many doctors consider low testosterone to be a "normal consequence of aging" and believe it is not necessary to treat "low T" until it falls to critically low levels. Some men want to "grow old naturally" and shun therapy… a reasonable point of view if your levels are indeed natural. The other important reason to understand this is because it changes "how" we should be treating low testosterone in most men.

 

Two Patterns of Low Testosterone

In the past most men with low testosterone had "Testicular Failure" known by doctors as "Primary Hypogonadism". In this condition the brain keeps sending out messages for more testosterone in the form of two hormones mentioned above, LH and FSH. When the testicles are too aged to produce an adequate amount of testosterone despite the normal signals, this condition develops. This is easily recognized as blood levels of LH and FSH are elevated yet the testosterone level is low. In this condition, supplemental testosterone is about the only therapy that works and is the treatment of choice.

Today, however, most patients who come in with symptoms of low testosterone have low testosterone and low or normal levels of LH and FSH; in this case the hypothalamus is not signaling the testicles to release more testosterone although they may very well be capable of producing it. Doctors know this condition as "Secondary Hypogonadism". If this type of patient is placed on testosterone, the levels of LH and FSH fall further and the testicles are not stimulated to produce testosterone. The man may experience a decrease in size of his testicles and may produce less of his own testosterone, less semen and may even become infertile over time.

 

Many Potential Therapies…

Which One is Right for You?

The good news is that if a man is suffering from secondary Hypogonadism there are several therapies effective in getting a patient’s testicles producing testosterone again, naturally. This keeps them from becoming prematurely dependent on pharmaceutical testosterone and helps them maintain fertility as well as normal testicular mass and seminal volumes.

The easiest, readily treatable cause of secondary Hypogonadism is an elevated level of estradiol in men’s blood. Adequate levels are very important to a man’s vascular health but if the levels creep up too high, the hypothalamus senses this and stops releasing LH and FSH and the testicles stop producing testosterone. By bringing down the estradiol level either through diet changes, herbal therapies or prescription medications, men’s bodies may start producing testosterone once again on their own. If estradiol is normal, the low LH and FSH may be due to the presence of other estrogen-like toxins in the blood. HCG therapy is often very effective at raising testosterone levels back to normal in this scenario and has been used in this way for decades.

 

Pitfalls of Testosterone Therapy

Despite whether a man has primary or secondary Hypogonadism, testosterone replacement therapy might be part of the answer but it needs to be done carefully for maximum long-term benefit. After replacement therapy starts, many men start out feeling great with increased energy, increased memory and clarity of thought, increased confidence, decreased anxiety and more physical and sexual stamina. When topical preparations are used, the levels of testosterone in blood often do not represent the actual amount of testosterone in the blood, and men are often given too much testosterone. If you are just starting therapy, make sure you start on a lower dose, go slow and ease your levels up until they are just high enough to control your symptoms.

The other common problem is that some of the testosterone may aromatize into estrogen in men’s bodies, negating the effect of the testosterone. If this is tested for and identified, it can easily be controlled by a very low risk and inexpensive prescription drug or even with some readily available herbal therapies. Make sure your doctor pays careful attention to estradiol levels throughout the course of therapy.

So men, talk with your doctor about testosterone and check to make sure your levels are adequate. Make sure you and your doctor understand the significance of each of these lab values and the pitfalls of therapy before deciding on the therapy that is right for you. And ladies, please encourage your men to get checked out… you’ll both be glad you did!

 

Dr. James Raniolo is the Medical Director of the St. Pete Center for Optimal Health. He is board certified and advanced fellowship trained in Anti-Aging and Regenerative Medicine as well as Family Practice. Contact him at spcoh.com.