Low T: Don’t Buy All the Hype. Here’s the Straight Skinny

By Roy M. Arnold MD

Anyone who watches television or reads magazines knows that advertisers would have you believe that every ache or pain of men over 40 is a direct result of low serum testosterone. After age 30 some men’s testosterone level declines by about 1% annually. It varies from person to person and the only way to really know whether you are affected is to have your blood testosterone level measured.

The prescription testosterone industry generates $1.6 Billion annually and is predicted to hit $5 Billion by 2017. The over-the-counter supplement industry revenue is not available but is probably about half as much. Not every man over 40 needs to be taking a testosterone supplement or booster. This article will reveal what works, what doesn’t and some non-pharmaceutical ways to boost your testosterone.

First, what does testosterone do? Testosterone or T is a hormone produced by the gonads (testes and ovaries) and adrenal glands that stimulates muscle development, hair growth and sex drive in men and women. Women produce significantly smaller amounts than men do. The T levels do decline in both sexes with age. Testosterone is also stored in body fat so it stands to reason that the higher the percentage of body fat, the less testosterone is available to work on the target organs like muscle cells, sex organs and the brain. In contrast to what you may have heard in advertisements, testosterone is not a cure-all for the signs and symptoms of aging and poor physical conditioning.

An important non-pharmaceutical way to boost your testosterone is through diet and exercise. A low carbohydrate diet with plenty of lean protein paired with an exercise regimen that focuses on sprints and weight training will reduce total body fat and boost your own testosterone level. The best exercises include both upper and lower body weight training with fairly high weight loads. Yes, it will take some time and effort but it’s much less expensive and provides excellent long term health benefits.

There are any number of over-the-counter supplements that promise to boost your testosterone levels. Most of them don’t work at best and at worst can have very undesirable side effects. Testosterone analogs in OTC supplements were removed from the market in 2005 because of the potential for liver damage. The so-called natural testosterone boosters like Tribulus terrestis or DHEA have not been shown to increase serum testosterone levels in double-blind trials, and more importantly they often lower HDL or “good” cholesterol  levels and can cause breast enlargement. Men’s Health magazine published an article online November 5, 2013 that has more information about OTC testosterone boosters.

If losing weight and exercise don’t help, you should consider having your total and free testosterone levels measured. If they are low, your doctor may prescribe a testosterone supplement. Because of the potential for abuse these drugs are considered Schedule 3 controlled substances just like some painkillers. Also because of the potential for liver damage when taken orally, they are only available by injection or in topical form. If you aren’t needle phobic and don’t mind getting an injection every 2 weeks or so, testosterone injections are the least expensive testosterone supplements. Compounded mixtures containing testosterone in moisturizing cream or transdermal patches are somewhat more expensive but require daily dosing. The most expensive route is the prescription gels applied under the arm or to skin which cost $300-400 per month. Any testosterone supplement applied to the skin can be transmitted to another person by close contact. If contact with a woman or a child transfers the drug, hair growth, deepening of the voice and early puberty in children can result.

The goal of T supplementation in men or women is not to boost the level as high as possible but to raise it to mid-normal levels, around 4-500 nanograms per 100ml of blood for men and 30ng for women. Too vigorous supplementation has been shown to increase all-cause mortality and in particular the risk of cardiovascular events. The most recent publication on this topic was in the Journal of Clinical Endocrinology & Metabolism, November 20, 2013 edition.

In summary, don’t believe all the hype about miraculous vigor and instant strength from either testosterone supplements or OTC boosters. They are expensive and often don’t provide the promised results. First and foremost, see your primary healthcare provider for a checkup. Ask about having your testosterone measured. If you are overweight and/or out of shape do what you can to improve that situation. If your level is low and your healthcare provider agrees, start on a low replacement dose with periodic monitoring to ensure your level hits the target.