We have all heard the expression, “less is more.” However, in the case of testosterone replacement, “more” can actually be “less.” Our bodies do not differentiate naturally produced testosterone from that purchased from a pharmacy. In turn, our natural production plummets in response to this replacement. Even after discontinuation, this decrease can last many months or longer, depending on the duration of therapy. Let’s answer the five most common questions about this elusive male hormone.
Who needs testosterone replacement?
If you listen to the ads about “low T,” you would think every man could benefit. However, a low level is not enough—at least one related symptom or condition must also exist. The most common problems related to low T are decreased sexual drive and erectile dysfunction. Other conditions that justify replacement include low bone density, diabetes, recent muscle loss, and metabolic syndrome (characterized by insulin resistance, increased central body fat, and abnormal lipid panel). Low T can also lead to symptoms such as fatigue or depression, but these common conditions may be unrelated to the hormonal deficiency. In any case, you should rely on guidance from your physician.
Who should be tested for low testosterone?
All adult men with consistent signs, symptoms, or associated conditions of low T should undergo testing.
How can you raise your testosterone levels naturally?
Moderate and regular exercise is the most reliable way to increase your testosterone production naturally, with resistance training having the greatest effect. Consistent quality sleep is also essential to maintain your testosterone level. Since stress can increase your blood cortisol (an inhibitor of testosterone), stress management can also be crucial. Of course, exercise and sleep are very effective in reducing stress. Although a high body-fat percentage will decrease hormone levels, a healthy dietary fat intake in moderation is still needed for your body to manufacture testosterone. Other dietary recommendations include vitamin D supplementation and minimizing alcohol consumption.
Can testosterone cause heart disease?
Interestingly, too much or too little testosterone can be associated with an increased risk of heart disease. The goal of replacement therapy is to maintain normal levels.
Can testosterone cause prostate cancer?
Testosterone does not cause prostate cancer. However, men with a history of high-risk prostate cancer (or untreated prostate cancer) should avoid replacement unless otherwise advised by a urologist. In addition, PSA blood levels should be monitored carefully after starting testosterone replacement in order to screen for prostate cancer.
As you can see, low T can be one of the most over-diagnosed and under-diagnosed conditions that we see in men. It all starts with awareness, education, and testing. Look for my article on “The Heart and Soul of Men’s Health” in the next issue.
Scott D. Miller, MD, MBA, is the Medical Director of Robotic Surgery at Wellstar North Fulton Hospital. He is a urologist with Wellstar Urology in Roswell and has practiced in Atlanta for over 20 years. Wellstar North Fulton Hospital offers the Know Your Heart Screening that can determine your risk of heart disease, stroke and other serious conditions. Call 770-956-STAR (7827) to learn more or schedule an appointment.