Is a man the sum of his testosterone levels? It's a question that's been on my mind over the last few days, since I stumbled across a fascinating hourlong episode all about the hormone on the NPR radio show This American Life. The segment features an eerie but enlightening tale of a man who stops producing testosterone due to a medical treatment and discovers that life without testosterone is essentially a life without desire. And not just sexual desire but desire for anything: be it food, conversation, and even TV. The man, oddly enough, describes it as somewhat "pleasant"; it sounds to me more like some strange sort of torture.
I'm not about to run off and get my testosterone levels tested like the producers of This American Life did for their show, but I will say hearing that episode makes me wonder where I fall on the testosterone spectrum. Testosterone levels start falling about 1 percent a year once men hit middle age, and it's a bit alarming to imagine something as central as my personality changing because of a dwindling hormone. Apparently when testosterone levels fall far enough, doctors even have a name for it—several names, in fact. Andropause, androgen deficiency, late-onset hypogonadism, and even "male menopause" are some of the labels bandied about.
Some physicians think that stopping the decline with supplemental testosterone is a good way to alleviate symptoms commonly associated with aging such as bone and muscle loss, sexual dysfunction, and depression. Others argue testosterone therapy is a futile attempt to stop the natural aging process—and one laden with side effects. The debate isn't likely to end anytime soon, but we did get some interesting news on the topic this week from the Archives of Internal Medicine. A team from the Massachusetts-based New England Research Institutes found that about 6 percent of 1,486 men tested in the Boston area had androgen deficiency and that of those men a majority—88 percent—were not receiving testosterone treatment despite, as the study put it, "adequate access to care."
"We don't know the reasons why few men with the condition were actually treated," says Susan Hall, the NERI epidemiologist who led the study. She notes that the cost of the drug or the fact the condition can easily go unrecognized may be factors.
The language of the study subtly implies that the men not on testosterone were missing out on the best care available, but there's good reason that many doctors have been reluctant to prescribe testosterone therapy. The Mayo Clinic, for example, has conducted a review of the science that concludes there's little evidence that using testosterone improves sexual dysfunction or is safe from a cardiovascular standpoint. And they publish a laundry list of potential side effects, including skin reactions, baldness, sleep apnea, testicular shrinkage, limited sperm production, excess blood production, and acne. Perhaps most frighteningly, testosterone therapy may stimulate the growth of prostate tumors.
If I were considering testosterone therapy, I'd be wary of the aggressive marketing of the various patches, gels, and creams that can be used to administer the hormone. The Internet is awash in testosterone supplements aimed at men, and plenty of them don't fully explain the potential risks and uncertainties associated with testosterone treatment. There are other ways to increase testosterone levels, according to this article and this one, so I'd make sure that I had tried some other strategies—such as getting enough sleep and eating right—before signing on to any sort of testosterone treatment plan.
I'm interested in hearing from readers who have low testosterone and have tried supplementation. Has it helped? Have you encountered side effects?