Should T-Replacement Therapy be Considered as a Last Resort Only to Undesired Physical Changes in Males?
In December 2014, Spanking FIT investigated the vitamin D- testosterone connection and explained how getting adequate exposure to sunshine, especially in the right places, may be a natural solution to the male problem of hypogonadism, more commonly known as low testosterone or “low-T”. (See “Male with Low-T? Try Nude Sunbathing”) “Low-T” has received considerable media attention recently, from television to the internet. Many of the “symptoms of aging”, from loss of bodily hair to belly fat, have been labelled as low T symptoms, and most medical doctors have reported a surge of inquiries from their male patients regarding personal T readings, low T treatment, and low T supplements . Increasingly, T-replacement “therapy” is being performed on a regular basis, and the number of prescriptions for ointments, creams, and testosterone patches has skyrocketed.
Why do men and their physicians worry about T?
What usually contributes to male low T worries, besides heavy media advertising, are the following common symptoms: weak or infrequent erection, reduced sex drive, decreased energy and muscle mass. If low T is the suspected culprit, the next step naturally is for the physician to measure the patient’s total or serum T level. However, basing medical decisions on total T value alone can be a major mistake. First, there are a variety of T types present in our bloodstreams. Most of the total T is of the non-bio available kind- T bound to sex hormone binding globulin (S.H.B.G.). Only so-called “free T” and “albumin-bound T” are proven biologically active and available to influence metabolism. Basing a medical decision on a total T reading only often leads to misdiagnosis in either direction (i.e., patient with low-T or normal-T). Secondly, T values vary considerably from one individual to the other. In “Androgen and the Aging Male”(1996), Alex Vermeulen, of Ghent University in Belgium, presents a summary of his work in computing mean plasma sex hormone levels in “healthy” men broken down by age. So, for example, based on a sample of 45 men between the ages of 25 and 34 years old, mean total T was 617 ng/dL with a sample standard deviation of 170. The results imply an expected “usual” range of values between 277-957 ng/ dL. However, for diagnostic purposes in judging whether a patient is “normal” or not, statistically it is superior to use a 95% confidence interval on mean T of 566-668 ng/dL. By the way, seldom is it done this way by physicians in clinical practice. That’s because most medical school programs still do not require the study of Statistics, even in this day and age! T values also normally decline with age and average decreases are about 15% by the age of 70, according to same work (opposing “by more than 50%” as reported by some sensationalist web sites). On October 13, 2014 Spanking FIT presented its philosophy in making legitimate health decisions based on data (see About Us page). One of our stated principles was never to underestimate the importance of bio individuality before undertaking any medical intervention. A T value low for one individual, might actually be high for another. Is it advisable for a physician to immediately place a man who is experiencing undesirable physical changes, and whose T level is at the lower end of the scale for his age, on replacement therapy? More and more physicians appear to be adhering to this practice and at the same time overlooking the fact that T-replacement therapy is not without risk. According to the well-regarded web site “webmd.com”, potential adverse side effects of T-replacement therapy include: stimulation of prostate tissue with increased prostate specific antigen (P.S.A.) levels and increased cancer risk; increased risk of blood clots forming with possibility of stroke; decreased testicular size (good heavens!); increased aggressiveness and mood swings that mimic bipolarism; unwelcome cholesterol changes, etc., etc.
Spanking FIT’s advice to men who experience certain undesired physical life changes
Unless your T values are extreme “outliers” (and, remember that T values, even for individuals, are not stable and need to be based on multiple measurements), try increasing your level of physical activity, first. Both aerobics and strength training are believed to slow down aging and increase human health span. We say “believed to” and not “definitely do” because there always are problems in designing controlled experiments with human subjects that clearly demonstrate this claim. Statistical correlation is not synonymous with causality, and the fact that high physical activity levels can be shown to be closely associated with long health span does not prove them to be their cause. Ideally in designing a study, one needs to divide a group of individuals into “treatments” who regularly exercise, and “controls” who do not, and then monitor their health prospectively over a period of years. This isn’t possible to do with humans for moral reasons. However, it has been done successfully with animal subjects including rodents. (Keep in mind, that according to geneticists we share about 80% of our genes with the common household mouse.) For example, in the American Journal of Physiology, 2004 A. Navarro, et. al. demonstrated that exercise increased life span, decreased oxidative stress, and prevented decline of cytochrome oxidase activity in mice. A decline in the latter is associated with defective mitochondrial cell function and greater risk of developing diabetes, Parkinson’s, atherosclerosis, and Alzheimer’s in humans.
Evidence appears lacking that “fit” men possess permanently elevated T- levels
Here’s an interesting scientific twist: Although exercise has been demonstrated to increase T levels immediately following workout, there appears to be a paucity of evidence to indicate that it increases resting levels of testosterone, which is by far the more significant parameter related to hormonal “improvement”.
For example, in “The hormonal response of older men to sub-max aerobic exercise” by D. Lovell, et al, published 2012 in the journal Steroids, both T and free T increased immediately following exercise, but no changes in resting hormonal concentrations were observed. Also, in “Resting steroid hormone concentrations in lifetime exercisers and lifetime sedentary males”,by L.D. Hayes, et al, published in 2014 in Aging Male, no significant differences in resting serum-T or resting free-T between the two groups were observed. Statistically speaking, the fact that no significant differences were found does not mean they do not exist; however, these findings do raise the interesting possibility that some members of the medical community may be barking up the wrong tree in believing that the secret to improved male vigor and strength lies in testosterone level “improvement” alone. The picture is far more complex, it seems.
Lower T-levels, particularly in older men, may actually be protective
Finally, research results out of Bolgna, Italy are worth mentioning. In the September 2014 issue of Andrology, G. Corona, et. al. present evidence to support an intriguing hypothesis regarding the “low-T syndrome” commonly experienced by older men. They believe that it may be nature’s way of protecting some men against cardiovascular events by slowing them down. Perhaps, we gents need to question the need to continue being manly and muscle-bound at an advanced age in order to impress the ladies (younger?). Let’s have your opinion. Dr. Garrett
P.S. Don’t forget to check out “Male with low-T? Try Nude Sunbathing” Dec. 2014 Spanking FIT. Thanks.
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