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Testosterone

I Pity the Fool Who Self-Diagnoses Low-T - Mr T | Meme Generator

Got low T?  Do what the British do ... High Tea!

As I was driving down the highway near Houston last month, I saw a banner in a strip mall for a male hormone clinic that advertised free testosterone screening.  Now even though being born in Texas is a natural testosterone supplement, this made me queasy.  It seemed like an effective way to scare men into buying something they probably don't need that could have some detrimental effects on them.

I get tons of questions about testosterone as 80% of the people I see are men, so I wanted to try to clear up a few things as best I can (for all the women, hopefully you have someone in your life you can apply this info to).  In addition to my own training in this, I also work 8-10 feet from our endocrinologists and so can hear their thoughts and shout clarifying questions to them, which I have, for quite a while.  And let me just say that the best information out there I can find comes from the Endocrine Society's webpage.  They have a good video too.

- Truly low testosterone levels are uncommon.  Oftentimes they can be falsely low because they are tested at the wrong time (needs to be done fasting between 7-10 am and repeated 2-3 times if low) or they are falsely low due to a recent illness or excess body fat (testosterone is sequestered in body fat so isn't found in the blood).

- People do not need to routinely have their testosterone levels checked, for the same reason we don't run the other thousand blood tests we have.  If there are concerns about low testosterone levels causing symptoms, that's when we investigate, but that's usually part of other lab work to check for other causes of the same symptoms and after an exam.

- While most men do develop trouble maintaining erections at some point between their 30's and 70's, it is NOT because of low testosterone levels.  Erections happen (wow I sound like my 5th grade sex ed teacher) because nitric oxide is made and it isn't made as efficiently as you get older.  Medications like Viagra, Levitra and Cialis work by making the nitric oxide producing enzymes stay active longer.  That's why all the ads say not to take them if you also take nitrates - it's like double dipping.  Anyhoo, research consistently shows that for guys with isolated erectile dysfunction, more testosterone does nothing.

- Truly low testosterone levels happen either because a) the testes aren't making it (primary hypogonadism - very uncommon in the adult population as more related to chromosomal issues) or b) they aren't being signaled by the pituitary or hypothalamus (secondary).  There are medications and medical conditions that can cause mild secondary hypogonadism but these aren't treated with testosterone, they are treated by fixing the underlying problem.

- Men who should be checked for testosterone levels would be those having some combination of low energy, fatigue, low libido that starts over a course of days to weeks.  There are a lot of other things that can cause those symptoms though such as depression, anxiety, hypothyroidism, and a myriad of other medical conditions.

- Testosterone levels naturally decrease as you get older but typically, studies have shown that low testosterone levels in older adults are more a sign of poor health.

- Some people with truly low testosterone levels who are symptomatic do benefit from being on testosterone supplements.  The medication probably isn't as risky as we used to think but may still cause an increased incidence of heart disease which is another part of why we don't recommend it too freely.

- So you might be saying if there's not much downside, why not try it?  The problem is that once you're on testosterone supplementation, your body stops making it naturally and may never start up again, which means you're on supplementation for the rest of your life and if you go off, you're going to feel terrible and may develop earlier onset of a few medical problems.

- I will never recommend any over-the-counter supplement that says it's a "natural testosterone booster."  At best, it's a placebo.  At worst, it's pumped full of other adrenal hormones that shouldn't be in there.
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