Testosterone to the Rescue

Testosterone gets a bad rap. All that most people seem to know about this hormone is that it makes men hairy, horny, and hostile, and that it's abused by athletes to build muscle and improve performance.

But there's much more about testosterone that you need to know. This crucial hormone has pervasive effects throughout the body, and low levels—which are much more common than you may think—increase risk of heart disease, diabetes, obesity, depression, memory loss, and a host of other maladies often chalked up to aging. Unfortunately, its reputation as a "dangerous anabolic steroid" prevents many menfrom reaping the profound benefits of supplemental testosterone.

The Quintessential Male Hormone
Testosterone first makes itself known in the womb. Male and female fetuses are pretty much the same until the sixth or seventh week of gestation, when a gene on the Y sex chromosome triggers the development of the testes, the male sexual organs. (Males have XY sex chromosomes; females have XX.) The testes produce testosterone and other hormones that transform the anatomy of not only the genitals but also the "organization" of the brain.

Although it may not be politically correct to admit, those of us who have raised children can attest to intrinsic differences between boys and girls—and this is due in part to the effects of testosterone. Stud- ies confirm, for example, that males and females differ in behavior (as a rule, boys are more rough- and-tumble) and problem solving (males are generally better at spatial and navigational tasks while females excel in verbal memory).

Throughout life, testosterone continues to exert its influence. Production revs up during puberty as boys become men, levels off in adulthood, and falls with age.

Nationwide Testosterone Levels Are Falling
Researchers from the New England Research Institutes determined that for every decade of life, on average, men experience a 14.5 percent drop in total testosterone and a 27 percent drop in free testosterone (testosterone that is not bound to proteins and avail- able to tissues). These rates of decline are somewhat lower in healthy men, but more significant in men who have health problems. For instance, weight gain - (adding four to five points to a man's body mass index, or BMI) lowers testosterone levels to a degree similar to that of more than 10 years of aging! Taking multiple drugs, losing a spouse, or having sleep apnea, diabetes, or heart disease also decreases levels.

But age-related declines aside, an alarming trend has been brewing over the past two decades. Average testosterone levels have been steadily declining, and this bodes poorly for the health of American men.

This same research team measured the testosterone levels of more than 1,500 men, ages 45 to 79, on three separate occasions between 1987 and 2004. They found annual declines of 1.2 percent in total testosterone and 1.3 percent in free testosterone, which adds up to a significant drop over time. The research- ers carefully factored in age, chronic illness, and other things that might influence levels, so the declines were not related to normal aging, health, or lifestyle.

Today, one in four American men over age 30 has a low testosterone level, which is defined as less than 300 ng/dL in total testosterone and less than 5 ngldL in free testosterone. The fact that only one in 20 of them has clinical symptoms of testosterone deficiency is of little consolation. It's like having a slow leak in your plumbing—you don't know about it until your floorboards rot out.

Testosterone Deficiency's Downside
A low level of testosterone has a decidedly negative effect on a man's health. It increases the risk of bone loss and muscle atrophy. It is clearly associated with diabetes (men with the lowest levels have more than double the risk of diabetes) and heart disease (levels are significantly lower in affected men). Moodiness, memory problems, difficulty concentrating, fatigue, loss of confidence, and diminished libido are all symptoms of testosterone deficiency.

Testosterone is even linked to longevity. Accord- ing to a 2006 study of male veterans, men with low testosterone levels had a 68 percent increased risk of death compared to those with normal levels.

Magical Effects of Testosterone Replacement
The good news is there's a solution: testosterone replacement. Once men start using supplemental testosterone, either in the form of topical creams and gels or regular injections, magical things often begin to happen. Sexual interest and performance perk up. Muscle mass, most noticeably in the shoulders and chest, makes a comeback. Men feel less grumpy and depressed, and more energetic and motivated.

But what's going on "beneath the floorboards" may be even more important. Supplemental testoster- one improves the way the body handles insulin. Meta- bolic syndrome—the cluster of conditions caused by insulin resistance (abdominal obesity, low HDL cholesterol, hypertension, and high triglycerides and C-reactive protein) that increases risk of both diabetes and heart disease—often improves after testosterone is regularly administered.

Testosterone also bolsters the heart muscle and improves symptoms in men with angina. As a therapy for cardiovascular disease, it shines brightest in the treatment of congestive heart failure. This condition is associated with inflammation and loss of skeletal muscle, and supplemental testosterone addresses both of these concerns. In a 2006 British study, men with heart failure who used testosterone for 12 months made significant strides in exercise capacity.

But Is It Safe?
When you read about the dangers of testoster- one, including shrinkage of the testicles, shutdown of sperm production, liver damage, and "roid rage" (aggression), those articles are referring to very high, abusive doses. Truth is, when properly administered, testosterone therapy is exceptionally safe.

Some men gain a little weight on testosterone, but it's usually associated with increased muscle mass. In fact, small studies suggest it may help with abdominal fat loss. It also raises the number of red blood cells, which is good if you have anemia, but you may need to give blood occasionally if levels get too high.

Oral testosterone, which I do not recommend, may harm the liver. Regarding prostate cancer, testosterone does fuel prostate cancer growth, so you should be screened before starting on this hormone. However, even though supplemental testosterone may raise PSA levels, it has been definitely proven that the treatment does not cause prostate cancer. UCLA researchers reported in the Journal of the American Medical Association last year that older men on a placebo actually had more prostate cancers than those treated with supplemental testosterone.

Patients Love It
We prescribe a lot of testosterone at Whitaker Weilness. One patient, whom I'll call Frank, had a heart attack two years ago, followed by the place- ment of stents in two of his coronary arteries. After that, things fell apart. Worried about his health, Frank became increasingly anxious, depressed, and fatigued. It got to the point that it was an effort to even leave his house. In addition to the drugs he took for his heart condition, his doctors prescribed multi- pie psychiatric drugs, but none of them worked.

Another patient, Sam, had even more remarkable results. After starting on testosterone injections, he lost 30 pounds, his cholesterol fell from 211 to 123, and his fasting blood sugar went from 170 to 130.

We even prescribe testosterone, the "hormone of love," for women. Small doses rubbed into the skin give libido a lift like nothing else can.

Recommendations:
• To determine if you're a candidate for testosterone replacement, ask your doctor to test your blood level. The ideal level for men of all ages is the normal range for young adult males.
• Testosterone requires a prescription, and it may be administered in several forms. At the clinic, we use injections every seven to 10 days of 200 mg (1 cc) of testosterone cypionate or daily applications of testosterone creams or gels. These are all available from compounding pharmacies. To locate one in your area, call the International Academy of Compounding Pharmacists (IACP) at (800) 927- 4227 or visit iacprx.org.
• I recommend that men on testosterone therapy also take 360 mg of saw palmetto daily to protect their prostates. Testosterone should not be taken by men with prostate cancer.
• To find a doctor schooled in natural hormone replacement therapy, visit the American Academy of Anti-Aging Medicine (A4M) at worldhealth.net. For an appointment at Whitaker Wellness Institute, call (800) 488-1500.

References
Malkin CJ, et a!. Testosterone therapy in men with moderate sever- ity heart failure: a double-blind randomized placebo controlled trial. Eur Heart J. 2006 Jan;27(1):57—64.

Marks LS, et al. Effect of testosterone replacement therapy on pros- tate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA. 2006 Nov 15;296:2351—2361.

Shores MM, et al. Low serum testosterone and mortality in male veterans. Arch Intern Med. 2006 Aug 14-28;166(15):1660—1665.

Travison TG, et al. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Cliii Endocrinol Metab. 2007 Feb;92(2):549—555.