MONDAY, MARCH 19, 2018
|Home » Health & Fitness » Story|
|Testosterone for sale|
As a husband, father, homeowner, and perhaps boss, he's farther up the mountain but his backpack feels heavy. He might wake up one day and discover that he now weighs, oops, 102 kgs, with very little of it muscle. He might find nothing in the tank for sex if it's a Tuesday and past 9:30. Maybe he hasn't met all the goals he set at 30. Worse, maybe he did. These are complicated burdens. Attempting to fix any one of them could be a huge challenge. How convenient, then, would it be if he could pop a pill that purported to be the rejuvenating answer? Given the choice between making life changes and filling a prescription for testosterone, it's an easy decision. But is the easy answer an effective one?
The fight to thwart male decline has been going on ever since the first guy with hair growing out of his ears plunked down a cheque for a four-wheeled mojo enhancer. But in the few years, the struggle to stay vital is increasingly being approached as a biochemical problem, one requiring pharmaceutical intervention in the form of testosterone replacement therapy (TRT). And we're not just talking about men over 50, or even 40.
Depending on who you ask, the turbocharged rise in the use of TRT shots, gels, patches, and pills is either (1) an inspiring transformation in how doctors treat a vast and despairing brotherhood of men, or (2) expensive quackery that targets male vanity and has nonexistent benefits and deadly risks. The fact that the symptoms driving men to testosterone therapy are often subjective and can easily resemble those of normal ageing, depression, poor sleep, or bad choices at the food trough only complicates the debate. Also not helping: Men's hormone levels are in a historic, culture-wide decline, under assault from a steady increase of obesity, painkiller abuse, food toxins, and estrogen-mimicking compounds in water and soil.
In March, the Food and Drug Administration in the US announced that it had asked drugmakers to add language to the labels of testosterone replacement products warning of increased heart attack and stroke risk. But in February, a large review of the literature concluded that the research indicting testosterone replacement as a heart risk is vastly outgunned by the research showing that it helps. Confused? You're not alone. "Unless you've gone through low testosterone, you don't know what it's like," says Bharat Sharma, a 55-year-old IT professional, who's also a testosterone user. "I'd like to take that doctor who is suspicious of the drug therapy and get his testosterone down to 259-to where he's got erectile dysfunction, he's about to lose his marriage, he can't think very well, and he's struggling in his practice."
He says TRT shots relieved him of a dysphoric mood-unease, anxiety, misery-that first took up shop in his cranium during his teen years. He says his testosterone turnaround gave him the energy to attack his job and responsibilities with renewed drive. "My cognitive abilities have never been www.MensHealthIndia.com better," he says. His focus has improved too. The pharmaceutical companies have not yet produced evidence that testosterone can help a guy dig that funky groove, but the oddness of the observation has an authentic ring. It makes you wonder if some sort of fountain of youth can be trapped in male hormones.
It's praise echoed by a man we'll call Sameer, a 43-year-old scientist who went on testosterone shots three years ago when blood work revealed that he had low levels of something called sex hormone binding globulin, or SHBG. For Sameer, it was lifestyle-related-he spread 98 kgs over a 6-foot frame, ate poorly, and found time to stress but not to exercise-and the SHBG deficiency was causing his body to burn through its available testosterone way too quickly. At the time, all he knew was that he couldn't get himself out of bed on most mornings.
"I had become a father but realised I wasn't being a good father," he says. "I would sleep in. I didn't have the energy to read a story to my children at night, and it caused a lot of tension in my marriage." Today, Sameer rides a bike and has more lean muscle, and his weight is under control. He says testosterone gave him the energy to do all that.
Those are the guys the testosterone industry wants you to hear from. But there are other guys too.
"I get a testosterone shot in the ass every week," says my childhood buddy Andy, 51, a marketing specialist. Andy couldn't tell you the exact blood level that triggered his decision. A single man, he's never had libido problems, and as for his physical condition, he trains at a place where professionals tune up. He thinks TRT has helped his body composition, but he isn't sure.
Combine the serious users with the guys doing it on a lark, and then throw in all the dudes who quit taking testosterone after a month (19 per cent, according to one study), and you're talking about millions of buyers of male hormones.
The questions are many. Are we encouraging people to take hormones we don't know they need, for a disease they don't have? What about the therapeutic options, or the latest drug therapies available? What about those who feel less manly and the basic middle-aged wish to reexperience the sort of boner before breakfast that makes it hard to pee in a downward trajectory? (A hallmark of low testosterone is less morning wood.) But the phenomenon just may be wishful thinking on a massive and expensive scale.
Testosterone replacement therapy is currently approved only for the treatment of male hypogonadism, or lack of testosterone, caused specifically by a problem with the testicles or with certain parts of the brain-the pituitary gland and hypothalamus-that control the gonads. You might inherit such a state, or it could be caused by injury or such conditions as a brain tumor or an undescended testicle. Men with these types of hypogonadism have extremely low blood testosterone and symptoms like enlarged breasts, hairlessness, loss of muscle mass, low libido, and bones that break easily. According to a study in JAMA Internal Medicine, however, a quarter of men who supplement with testosterone never even bother having a blood test, and only half have been diagnosed with hypogonadism.
In 2010, in an attempt to differentiate what was becoming known as "late-onset hypogonadism" from normal, age-related T decline, researchers analysed data from the European Male Aging Study, which followed more than 3,000 men, ages 40 to 79 in eight countries. They found that out of 32 symptoms often mentioned in the same breath as "low T," only three-a decrease in sexual thoughts, fewer morning erections, and erectile dysfunction-were associated with low levels of the hormone. "Low" was defined by the researchers as a total testosterone blood level of 320 nanograms per deciliter (ng/dl) or less and a free testosterone of 220 picomoles per litre or less. Anything more nebulous, in other words, and you're just turning to TRT because life is getting weird on you. Hell, some experts argue that even having these symptoms and coming in at or under these levels doesn't justify the drug. That matters, because as a number of recent studies have suggested, taking testosterone may double or even triple your risk of heart disease.
So here's the bad news: Increasing your testosterone can thicken your blood and lower your good HDL cholesterol, both of which hike your odds of heart disease. Researchers first began to learn of testosterone's link to cardiovascular risk between 2005 and 2009, when a team in Boston set out to determine if frail older men became more mobile after having their man juice jacked up. Their study, published in the New England Journal of Medicine, noted that the added testosterone made the men stronger on the leg press and chest press and climbing stairs. However, the trial was halted because 23 of the 106 men taking it developed cardiovascular problems, versus only five of the 103 men who'd been using a placebo gel.
By April 2013, researchers writing in BMC Medicine had sorted through thousands of results in 27 clinical trials and also determined that the risk of cardiovascular events went up for men on testosterone. (Curiously, this risk became apparent only in trials that were not paid for by the makers of the drugs.) Then in November 2013, researchers for Colorado's Veteran's Affairs system wrote in the Journal of the American Medical Association that they'd analysed the data from 8,000 men with low T who had gotten an angiogram before going on the hormone. Three years after starting, 26 percent of the men on testosterone had either experienced a new cardiovascular event or died, versus only 20 per cent of the men who didn't take testosterone.
Another alarm sounded in 2014, when a study in the journal PLOS One, looked at the health records of 55,000 men and found that testosterone use had doubled the risk of non-fatal heart attack in men over 65 and tripled the risk in younger men with a history of heart disease (younger men with no heart disease fared well on the drug).
"The PLOS One paper excluded anybody who died of a heart attack," says John Morley, MD, a low-testosterone expert at Saint Louis University School of Medicine. "It may well be they found a higher level of heart attacks in men on testosterone because those men lived while the others (who didn't take it) died."
As for the NEJM study of older men and mobility, "It is good that it was a random controlled trial," says Martin Miner, MD, codirector of the Men's Health Center at Miriam Hospital in Providence, Rhode Island. "But what was poor was that it really wasn't a safety study. We don't normally start elderly men with a history of heart failure on such large doses of testosterone." In other words, the research wasn't the best way to find out if testosterone is dangerous.
Blame the fog of T research. "I'm not saying testosterone is safe or unsafe," says Dr Miner. "I'm just saying those studies are so complicated, that for the lay public to interpret from them that a product causes significant risk is inappropriate. And just because heart disease is associated with low testosterone doesn't mean it was caused by it," he adds.
This confusion is why many of the nation's hormone experts specifically recommend against screening for low T; they just can't say whether low T is an important health problem or not.
What can testosterone do? "When you look at clinical trials of people with moderate or mild low testosterone receiving physiologic testosterone replacement," says Dr Montori, "the impact on quality of life and sexual function is either minimal or nonexistent."
Dr Morley disagrees: "Poor libido and a poor quality of erection are the symptoms most related to poor testosterone," he says. "There is also a subset of people with low testosterone who have fatigue, who are unhappy, and who don't have strength. They look like they're depressed, but they actually have low testosterone." Except here, too, the science isn't on his side: The European Male Aging Study results also show that psychological symptoms had little or no association with testosterone levels.
John La Puma, MD, is a critic of using TRT without a diagnosis of hypogonadism. The California-based internist and author, Refuel: A 24-Day Eating Plan to Shed Fat, Boost Testosterone and Pump Up Strength and Stamina, wrote a widely shared op-ed arguing that low T was a pharmaceutical-industry-generated sickness. But he'll readily acknowledge that the decline in testosterone is real. He says it's the causes of low T we should be talking about and correcting.
Alcohol lowers testosterone. So do steroids, stress, and opioid painkillers. There are also testosterone-diminishing forces in the environment to be considered. A study in the journal Fertility and Sterility found a specific association between exposure to phthalates (a group of chemical compounds widely used in soft plastics) and male infertility. These so-called endocrine disruptors can invade your system every time you heat up foods in plastic containers, plates, or wraps. Still, the smart money says the primary cause is in front of our eyes, and down about 18 inches.
"I think it's pretty clear that men gain weight in the belly," says Dr La Puma. "We tend to overeat starchy, sugary foods-incredibly efficient at making men obese." Men's belly fat cells convert their testosterone into estrogen, he says, and can make testosterone plummet.
"If you have an epidemic of obesity, an ageing of the population, and increased stress and stress hormones," says Dr Montori, "all those things should go hand in hand with loss of testosterone on average in the population."
That's why even supporters think testosterone therapy is only meaningful if it triggers men to do what's right for their health. "I am not in any way advocating the use of testosterone for treating obesity," Dr Morley says. "The risks don't seem reasonable to me."
And Dr Miner agrees: "Testosterone without exercise and diet or lifestyle change is of very little value."
"Small changes can make a big difference when guys learn how their bodies work," adds Dr La Puma. "If you tell guys the reason their testosterone is dropping is because of their belly fat cells, they go, 'Really?' Then if you tell them that their belly is not just a spare tire but an active endocrine organ, men like to know that. It helps them know that their belly fat is breaking them, and that it's a fixable problem." Specifically: It's fixable without turning to a shot of testosterone.
|Home | Health & Fitness | Nutrition | Sex & relationships | Style & Grooming | Celebrities | Photos|