TESTOSTERONE FOR OLDER MEN
By Dr. Gabe Mirkin, M.D.
Six million North American men spend more than 1.6 billion dollars each year to take the male hormone, testosterone, by shots, pills, gels and patches.
Many of them should not be taking testosterone because they do not need it. Furthermore, they may be harming themselves because testosterone can cause blood clots, strokes, infertility or liver damage; and increase the growth and spread of existing prostate tumors.
MEN SHOULD NOT TAKE TESTOSTERONE IF THEY HAVE ERECTILE DYSFUNCTION WITH HIGH DESIRE
Lack of testosterone almost always causes lack of desire, so men with erectile dysfunction and high desire need a careful work up of their hearts rather than a prescription for testosterone.
The most common cause of erectile dysfunction is blocked arteries to the penis. Men who have this condition also usually have blocked arteries leading to their hearts and are at significant risk for heart attacks.
WHAT IS A NORMAL TESTOSTERONE?
13.8 million North American men over 65 have low blood levels of testosterone.
A normal blood level of testosterone is 250-800 ng/Dl. Testosterone levels start dropping after age 30, and continue to drop at the rate of one percent per year.
Testosterone levels vary throughout each day and from season to season. Levels can drop in the winter, and rise after you exercise or make love.
WHAT ARE THE BENEFITS OF TAKING TESTOSTERONE?
Low testosterone can cause depression, lack of interest in making love, bone loss, and muscle weakness.
Therefore, a man with low levels of testosterone and loss of libido, depression, bone loss or muscle weakness may benefit from taking testosterone.
However, many men who have blood levels below 150ng/Dl have no symptoms whatever and usually should not take testosterone.
HOW THE BODY PRODUCES TESTOSTERONE
A man’s brain (pituitary gland) produces a hormone, called FSH (Follicle Stimulating Hormone) which stimulates the testicles to make testosterone.
As testosterone levels rise, they circulate in the blood back to the brain to stop the brain from making FSH.
When blood levels of testosterone are low, the brain tries to raise testosterone by putting out ever-increasing levels of FSH.
Most men who suffer from testosterone deficiency have low blood levels of testosterone and extremely high levels of FSH because the brain is producing large amounts of FSH to force the testicles to raise blood levels of testosterone.
As a general rule, no man should take testosterone unless he has:
* symptoms of a deficiency,
* low blood testosterone levels and
* very high levels of FSH.
MEN SHOULD NEVER TAKE TESTOSTERONE FOR INFERTILITY
Since taking testosterone raises blood levels of testosterone, it shuts off the brain hormones that stimulate the testicles. A man who takes testosterone will shut off the brain hormones (LH) that cause the testicles to make sperm, and become unable to make a woman pregnant.
WHAT IF A MAN HAS LOW TESTOSTERONE AND LOW FSH?
If a man has low blood levels of testosterone and low levels of the brain hormone, FSH, his brain is not producing enough FSH to stimulate the testicles to make testosterone.
This can have a very serious cause, such as a dead pituitary or a brain tumor. Therefore, he should not be started on testosterone until he has consulted, and been cleared by, an endocrinologist who has checked the brain with a special MRI. Other hormone levels should also be checked.
IF YOU DO TAKE TESTOSTERONE
Since testosterone can stimulate a prostate cancer to grow and spread, you must be checked by your doctor for prostate cancer.
Testosterone can also raise red blood cell levels high enough to form clots, so you must get tests for red blood cell counts (hemoglobin and hematocrit).
It can damage your liver, so you should be followed with liver tests.
Dr. Pinna says:
This is obviously a common problem amongst men as low estrogen is a common problem amongst women. However, many times the cause of weak feelings is poor diet and lack of exercise.
Before any man or woman consults a doctor about their sexual status, they should ask themselves: “Am I in good shape?” If the answer is “No” then it would be advisable to correct the obvious than to seek a quick cure.