Testosterone therapy: Fountain of youth or just another fad?

By Dr. William Sturrock, Special to the BDN
Posted Feb. 21, 2013, at 11:40 a.m.

Long before Ponce de Leon went slogging through the Florida swamp, people have been searching for a magic potion to ward off aging. The first written remedy, recorded by ancient scholars in India, focused on improving men’s testicular health to stave off the fatigue, weakness and loss of sexual function that accompanies the aging process.

Since then, there has been no shortage of men eager to recover that mix of energy, positive mood, strength and confident sense of self-potency that they believe they had experienced during their “prime” years of early adulthood.

As recently as the 1920s, surgeons in Del Rio, Texas performed a much sought after procedure of transplanting goat testicles into the abdomen of their desperate male patients. It wasn’t until the late 1930s, however, when German scientists Ruzicka and Budendandt won the Nobel Prize for synthesizing testosterone, that we really began the modern era of research into this hormone’s role.

We cannot ignore the darker side of testosterone research in the 1940s when it was reportedly given by Nazi physicians to soldiers with the aim of increasing their strength and aggression. Later, of course, it would be abused by Eastern European athletes in the 50s and 60s, and we are still dealing with the problem of performance-enhancing drugs by today’s professional athletes. But with all the hype and controversy whether we really know about its proper role in men?

Fact No. 1: Men with abnormally low levels are more likely to experience symptoms of fatigue, weakness and sexual dysfunction, and to develop a variety of health problems including obesity, diabetes and osteoporosis. There is credible research that they may also have shorter lifespans than their healthier counterparts.

Fact No. 2: Men over 30 lose about 10 percent of their testosterone each decade, and around 15 percent of men over 50 will demonstrate low levels of this hormone that might be considered in the treatment range. Research has shown, however, that unless they have the associated symptoms above, replacement therapy will not prove beneficial or increase lifespan.

In other words if your body is actually functioning well on the lower levels associated with age, you don’t need “high-test” in the tank.

Fact No. 3: Poorly monitored treatment carries serious health risks including liver problems, excess red blood cell production (which in turn can cause a stroke), shrinkage of the testicles, infertility and excess growth of the prostate. Although good research shows it does not cause prostate cancer, it can lead to significant urination problems, and all patients need to have regular tests to monitor all of these potential problems.

Fact No. 4: There are several things a person can do to improve his own natural production of testosterone that will not transfer a single dollar from his pocket to the pharmacy, including:

• Avoid prolonged use of narcotic medication, such as methadone, oxycodone, etc. that can lead to testicular failure in younger men.

• Ditto for other toxins, such as heavy intake of alcohol or marijuana (listen up you guys in Colorado and Washington State) as there is a good scientific evidence of decreased testosterone with heavy smoking.

• Lose weight and increase exercise: both aerobic work to get rid of excess belly fat which has been shown to produce a harmful hormone mix, as well as resistance exercise especially for core muscles and thighs.

Let’s say you have adopted all these healthy habits, but are still having symptoms of fatigue, muscular weakness and decreased sexual function (and some experts include mood or sleep disorders) — is it time for a prescription? If your provider grabs for their prescription pad, he or she may not be doing you a favor just yet. Hormone experts tell us that two separate measurements on different days should be done because testosterone levels can naturally fluctuate. Indeed, some insurance companies are not paying for treatment unless these two different tests have been done. Also, your provider should get the baseline labs to monitor you for the problems that can develop, check again after two or three months of therapy and regularly monitor your prostate for potential problems due to overstimulation.

So what’s the bottom line? All males are going to see the natural decline of testosterone as we age, but most of us do not need a new prescription. There actually may be some benefits that having testosterone levels slightly lower than it was in our early 20s when our peak levels were distracting our brain from enjoying some of the more subtle things in life. And perhaps those young soldiers with their own naturally high testosterone levels following Ponce de Leon and other misguided leaders into foolish and dangerous adventures would actually have been better off watching the sunset from their hacienda in Spain, enjoying that glass of wine with their beloved.

This column is the second of three columns by Dr. William Sturrock about men’s health issues. Sturrock is Eastern Maine Medical Center’s men’s health consultant at Urologic Surgery of Maine in Bangor.

http://bangordailynews.com/2013/02/21/health/testosterone-therapy-fountain-of-youth-or-just-another-fad/ printed on July 29, 2014