Testosterone for Health

Testosterone is one of my favorite hormones to discuss because its popularity is very low compared to estrogen and progesterone. Especially woman who are familiar with bioidentical hormone replacement, usually estrogen and progesterone are highlighted in bioidentical hormone replacement but testosterone is only minimally discussed. Testosterone plays a part in many important reactions in the body. There are many causes of testosterone loss such as natural menopause or andropause, childbirth, adrenal stress or burnout, endometriosis, depression, chronic use of birth control pills, HMG coA reductase inhibitors, chemotherapy, and aging just to name a few. Interestingly after 10 years of oral birth control use, libido drops significantly (most likely due to lowered testosterone levels). HMG coA reductase inhibitors are pharmaceutical medications used to treat elevated cholesterol levels.

Fatigue is one of the most common symptoms that is expressed by my patients. No matter what they are coming in with or what diagnoses they have, fatigue is often at the top list of their concerns. Most of my patients want more energy and want to feel again like they felt when they were younger. As adrenal gland function is often overlooked in the differential diagnosis of fatigue, low testosterone is also overlooked. Low testosterone, sometimes occurring very early in young men and woman, can promote a significant and confounding fatigue. If doctors don’t know to look into low testosterone levels in men and woman, the etiology may be missed for years. Sometimes simply supporting the adrenal gland, reducing stress, and using supportive supplements can help improve testosterone levels in younger men and women. As people age, it is more difficult to improve testosterone levels without the use of testosterone.

Symptoms Associated with Low Testosterone

• Tendency to increased abdominal fat
• Low libido
• Less energy – tire from physical activity
• Loss of muscle tone
• Migraines (women)
• Breasts getting fatty (men)
• Erectile dysfunction (men)
• Hot flashes and sweats (men)
• Changes in cognition and/or memory loss
• Low self esteem (more in men)
• Anxiety

In four major studies, testosterone deficiency is linked to increased risk of all cause mortality. Low testosterone has also been connected to elevated fasting glucose in addition to elevated 2 hour post prandial glucose levels. Low testosterone is also connected to poor lipid profiles such as elevated triglycerides, total cholesterol, and elevated LDL cholesterol. Apo A Lipoprotein elevations and hypertension, high blood pressure, have also been linked to testosterone deficiency. Low testosterone puts people at risk of developing Type 2 Diabetes Mellitus and metabolic syndrome.

Testosterone is very important in bone density and may be even more important than estrogen and calcium. We get so pigeonholed into thinking the same things over and over again and when something is presented to us for years in a row, it becomes ingrained in our memories and our beliefs. So, what have we been taught? At least for women, we have been taught that you should drink your milk, get in the sun for Vitamin D levels, take calcium, and get on some bioidentical estrogen to preserve bone health for women. Low testosterone in both men and women is connected to increased risk for fracture. Specifically a study presented in the Journal of Clinical Endocrinology Metabolism in 2010, low testosterone in men is related to a significant increased risk for osteoporosis, heart disease, diabetes type 2, obesity, metabolic syndrome, and overall increased inflammation.[1]

In a 10-year prospective study published by the National Institutes of Health of over 11,000 men aged 40 – 79 years old. The study found that those with high endogenous testosterone had low mortality from cardiovascular disease and cancer. Men in this study that had testosterone in the 1000 range had 57% decreased chance of dying due to call causes.[2] Men with testosterone lower than 900 had an increased risk for developing Alzheimer’s disease. High testosterone in men is not associated with increased risk for prostate cancer. This is the main concern that I get from patients if we discuss testosterone use. Interestingly, elevated levels of estrone are related to increased risk for prostate cancer. This means, that estrogen levels are more importantly linked to prostate cancer rather than levels of testosterone.

Testosterone is also important for quality of life. Testosterone is decreasing decades earlier than it used to and is contributing to a myriad of aging related symptoms. Testosterone can be tested using a simple blood test. For males, total and free testosterone should be tested and for female, total testosterone should be tested.

[1] Dandona, P. and MT Rosenberg. A practical guide to male hypogonadism in the primary care setting Int J Clin Pract. 2010 May; 64(6): 682–696.

[2] Khaw KT et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation. 2007 Dec 4;116(23):2694-701. Epub 2007 Nov 26.