The truth about low ‘T’
If you’ve watched sporting events on television over the past year, you’ve likely seen advertisements touting treatment for “low T” or low testosterone levels in men. These ads began appearing frequently over the past few years, which led me to wonder why there’s a new focus on this condition.
For answers, I turned to Dr. Herman Singh Bagga, director of the Center for Men’s Health and Genitourinary Reconstruction in the Department of Urology at Allegheny Health Network.
First, I asked the doctor to explain what testosterone is.
Testosterone is the primary hormone produced by men, as opposed to estrogen in women. This hormone has many roles, including the development of reproductive organs.
“In adulthood, the hormone is associated with several main roles for men,” said Bagga. “The roles most commonly associated with testosterone are promotion of libido (sex drive) and maintenance of fertility (sperm production).”
Testosterone also plays a role in maintaining mood and sense of well-being, preserving bone and muscle mass and promoting lean body mass by affecting fat storage. Knowing this, it’s natural to conclude that maintaining high levels of testosterone would amount to eternal youth for men. Not so, said Bagga.
First, testosterone levels vary among men. What’s “normal” for one man may not be normal for another.
“The normal level of testosterone is not fully understood, but studies have suggested a normal level for an average man to be between 300 to 1,000,” said Bagga.
Values should be measured in the morning, since they vary during the day.
“Testosterone levels seem to decline with age and peak in a man’s 30s. Most men have a natural decline after this of 1 percent or more per year,” Bagga said.
Testosterone levels are not routinely checked in regular blood tests, mainly because of the variability of what is “normal” from one person to another. So how do you know when to ask your doctor to check your levels? Dr. Bagga said it’s important to notice whether you’re having symptoms of low T.
“Symptoms of low testosterone are broad,” he said. “The most commonly noted include low libido (decline in sex drive) which can also translate into difficulty with erections, lethargy and decreased energy levels, changes in mood, loss of muscle mass and increased fat/weight gain, loss of bone mass and osteoporosis and hair loss.” Certain risk factors also increase the likelihood of low testosterone including age, obesity and hormonal disorders. “When to check a T level is an individualized decision I make with my patients.”
Bagga believes there are many factors that contribute to an increased focus on low testosterone.
“First, it has definitely become more treatable. In the past, there were very limited options for therapy, making finding a good option difficult,” he said. “Furthermore, there were many concerns about the risks of testosterone replacement therapy (TRT) including cardiovascular risks and blood clot or stroke risks. With time we have been able to study TRT carefully and although there are always risks with any therapy, for many men, we have found it to be a good, safe option for appropriately monitored patients.”
Treatment does come with risks, however. According to the Mayo Clinic, it could contribute to sleep apnea, cause acne and other skin reactions, enlarged prostate and breasts, and limit sperm production. Some research also points to an increased risk of blood clots and heart disease, but study results are mixed.
“Testosterone replacements are indeed heavily advertised as many seem to look at such therapies as a ‘fountain of youth’,” said Bagga. “The claims of such advertisements should be taken with a grain of salt – there can be other reasons for symptoms that are often seen with low T as well, so full medical evaluation is very important.”
If you are diagnosed with low testosterone levels, there are several options for replacement therapy. Transdermal therapies like creams, foams and gels are the most common, along with patches you apply to the skin. Injections are another option.
“Traditionally, we only had injections, which provided a ‘boost’ that quickly went away, requiring injections weekly or every other week,” said Bagga. “However, now we also offer long-term injections that can be injected five times a year in a doctor’s office with close monitoring.”
Another newer option is implanting small pellets that slowly dissolve over three to six months and require a relatively painless, 10-minute procedure to implant.
Bagga agreed that men are becoming more comfortable speaking about low T.
“There can be a stigma associated with some of the symptoms of low T, especially sexual dysfunction, and so discussing it can be difficult,” he said. That conversation seems to be getting easier to start with increased awareness plus the development of specialized men’s health clinics that provide a safe space to talk about such issues. “Men are more willing to confront the issue and seek treatment as appropriate. We are proud to provide such a space at my Men’s Health Clinic at AHN.”
Bagga suggests that those who have symptoms or questions about low testosterone, talk to their primary care doctor.
“It is helpful to work with your primary care doctor as well as specialized doctors such as myself who work with the condition and can provide replacement therapies if required,” he said.
Bagga stressed that it’s important to determine whether conditions could be contributing to symptoms mimicking or promoting low T, such as thyroid issues, diabetes, cardiovascular issues or sleep apnea.
“It is also important to take lifestyle steps to naturally improve T levels,” he said, “such as eating a healthy diet, exercising regularly, managing stress, getting appropriate amounts of good quality sleep and not smoking.”