Testosterone Deficiency
Background
Just as it is normal for estrogen levels to drop in women, this is also common in males, and has been called "Andropause." Its significance goes well beyond erectile dysfunction.
Low testosterone is also associated with:
- Depression and loss of motivation.
- Elevated risk of high blood pressure, high cholesterol, weight gain and/or diabetes (called "metabolic syndrome").
- Loss of muscle mass.
- Increased risk of Alzheimer’s.
Testing for Low Testosterone
This is another case where some physicians don’t understand the difference between a test’s result being in the normal range vs. being healthy (see "The Problems with Lab Testing"). It is important to also check the free (not just total) testosterone.
Be sure that the normal ranges for the lab results are broken down by ten-year age groups: 31-40 years old, 41-50 years old, and so on. It is meaningless to have a normal range that includes 80 year-olds if you’re 28. Low based on the normal range means you are in the lowest 2% of the population (e.g., under 200), which is horribly deficient. A better approach? If you are in the lowest 30% of the normal range (a testosterone level under 450) and have symptoms suggestive of low testosterone, a treatment trial may be warranted.
Treatments
For men under 50, it is often best to simply stimulate your body’s own production of testosterone using a low dose of a medication called clomiphene, 25 milligrams each night..
In men over 50, I recommend using topical testosterone creams or gels, applying 25-50 mg to the skin each morning. This is available from regular pharmacies (Fortesta, Androgel or Testim gel), but the form made by compounding pharmacies is much less expensive if you do not have prescription insurance. Be aware that if the skin where it is applied comes in contact with a woman’s skin (e.g., after a hug or if you don’t wash your hands after applying the cream), this can result in very high, undesirable and unsafe levels in that woman’s body. Because of this, I prefer testosterone applied to the thighs (e.g., Fortesta or compounded) instead of the chest and arms. And you should always be sure to wash your hands after applying the cream. An even better approach to treatment? Subcutaneous testosterone pellets. More is not better though, and I suspect some doctors use too high a dose. I recommend 1,000-1,200 mg of the pellets each 3-4 months.
In case you’re thinking that maybe it would be good for your wife to get some of your testosterone to increase her libido, think twice:
- In women, raising testosterone too high can increase diabetes risk (the opposite of in men).
- If you raise her libido with your testosterone, she may have more sex — but it may not be with you.
So be careful to keep the testosterone on you!
Treatments You Really Deserve When You’re Over 45
Time for a tune up …
When your car starts running poorly, you know to take it in for a tune up. When you pick up your car, you expect it to be running much better, and often like new.
Unlike their cars, most people never get tune ups. Instead, they go for yearly "checkups" to see if they have "It" yet (cancer, heart disease, diabetes, etc.). Except relief for knowing that they don’t have "It" YET, they feel no better for the visit. In fact, recent research suggests that testing for "It", including prostate PSA testing, many mammograms, screening for stroke risk with carotid sonograms, and DEXA scan, likely cause more harm than good. To make matters worse, the current misguided advice to avoid sunshine, eggs, chocolate, tea, coffee, and salt given by many physicians can actually kill you. Basically, the way things are now, a good argument to be made to afford your doctor unless there is a problem — unless we change things.
This change is occurring as people recognize they deserve to feel great at ANY age. Instead of going into the physician each year to get scared, I suggest that it is better to go in each 2-3 years for a tune up.
Here is a sample "10 point Tune Up" to get at age 50.
The current myth that "aging isn’t for sissies" is being replaced by a new truth: 60 is the the 40!
Tune up for women at age 50
- Energy/overall vitality.
- Mental clarity.
- Sleep quality and quantity.
- Hormonal optimization:
- Thyroid: Check free T4, TSH and anti-TPO antibody, along with symptoms.
- Estrogen and progesterone: Hot flashes, poor sleep, energy, and cognitive function around ones periods, and loss of vaginal lubrication, suggest the possible need for bioidentical hormone replacement. A recent study showed that this does not increase breast cancer risk.
- Adrenal stress hormone: Sugar cravings and severe irritability when hungry, suggest deficiencies.
- Identifying silent diseases:
- Hypertension.
- Diabetes.
- Breast and colon cancer (begin having colonoscopies every ten years).
- Obesity.
- Sexual function: libido, pelvic pain syndromes, vaginal lubrication, urine incontinence (do you sometimes laugh so hard that tears run down your legs?).
- Healthy skin, hair and nails.
- Pain: arthritis and muscle pains, indigestion.
- Bone density (DEXA scan): These are not recommended in standard medical practices because they lead to the use of toxic medications that increase bone fractures after 5 years of use. Fortunately, the availability of very safe and effective natural treatments such as strontium, which is now supported by many studies, makes this test worthwhile.
- Mood, motivation and happiness: Empty nest syndrome issues, status of professional goals, and aspirations.
Tune up for men at age 50
- Energy/iverall vitality.
- Sleep: Get at least 7 hours sleep a night, treat insomnia, and screen for sleep apnea.
- Diet assessment and counseling: Avoiding excess sugar and increasing whole and healthy foods (e.g., whole grains, fruits, vegetables, eggs, chocolate, and in moderation, tea, coffee, and alcohol).
- Thyroid, testosterone and adrenal (stress hormone) function, and sexual function.
- Exercise: Encourage, at least 30 to 60 minutes of outdoor exercise at least 3 days a week.
- Hypertension, diabetes, and Candida (suggested by irritable bowel syndrome or chronic sinusitis) screening.
- Weight optimization.
- Muscle and joint pain.
- Digestion: Treat indigestion and reflux by improving digestion, rather than further crippling digestion with acid blockers.
- Mood, motivation and happiness: Midlife crisis issues, relationships, status of professional aspirations.