A recent episode of the comedy series “The Building’s Only Murder” explores the topic of hormone therapy that many men seek as they get older.
Steve Martin’s character, Charles Hayden Savage, a washed-up actor turned amateur detective, proudly shares how testosterone therapy has enhanced his vigor. “Yesterday I opened a pickle jar as if it was nothing,” he quips.
While chatting with Oliver Putnam, a fellow resident obsessed with crime, Savage reveals his struggle: “If I’m honest, I’m really fighting the urge to get you now.” He adds that testosterone therapy is supposed to help with energy levels and bone strength.
Understanding Testosterone
Dr. Petar Bajic, an expert with the American Urology Association, explains that testosterone is mainly produced in the testicles, with a small amount coming from the adrenal glands. In teenage boys, testosterone production kicks off due to signals from the pituitary gland.
“Testosterone deficiency is quite common, affecting nearly 10% of men over 50.”
The National Institutes of Health notes that hormones play essential roles in maintaining muscle mass, sexual drive, sperm production, and regulating hair growth and body fat in men. As men age, testosterone levels typically decline. According to Bajic, nearly 10% of men over 50 experience this deficiency.
Low testosterone can stem from several issues, such as problems with the brain’s ability to regulate hormone production, testicular damage, cancer, chemotherapy side effects, thyroid disorders, obesity, and certain medications.
Symptoms and Diagnosis
Dr. Tanya Munger, an endocrinology nurse at Duke University, points out that many symptoms of low testosterone can overlap with other health concerns. Some signs to watch for include:
- Reduced sexual drive or erectile dysfunction
- Infertility linked to low sperm count
- Depression, lack of focus, heightened sensitivity
- Increased body fat
- Loss of muscle mass or strength
- Fatigue
- Decreased bone density
- Reduced hair growth
- Breast enlargement
- Sleep disturbances
Munger suggests that men concerned about their testosterone levels should consult their primary care physician for blood tests. A diagnosis typically requires two tests taken early in the morning showing low testosterone levels. While levels below 300 are often considered low, it varies by testing lab.
If tests show normal testosterone, it’s important to explore other reasons for symptoms, according to Dr. Susan Splatt, also an endocrinology expert at Duke.
When to Seek Treatment
Dr. Bajic advises that the first approach to low testosterone should involve lifestyle changes like diet and exercise. If those don’t help, testosterone replacement therapy may be suggested. Options include gels, injections, and pellets, as well as oral testosterone.
However, treatment is generally reserved for men showing symptoms of hypogonadism, a condition of insufficient testosterone production. Diagnosing hypogonadism can be tricky, as symptoms can resemble other medical issues.
Potential Risks of Treatment
Spratt warns that testosterone therapy can elevate red blood cell counts, which might sound beneficial but can lead to strokes and blood clots when levels get too high. Moreover, testosterone can enlarge the prostate and potentially worsen existing prostate cancer.
Possible side effects of testosterone treatment might include:
- Acne or oily skin
- Reduced sperm production
- Shrinking testicles
- Aggression or mood swings, especially at high doses
- Gynecomastia or increased breast tissue
While there’s some evidence linking testosterone therapy to heart disease, the findings are somewhat conflicting, as noted by Munger. It’s crucial to maintain testosterone levels within a normal range to minimize risks.
The goal of testosterone replacement therapy is to return hormone levels to normal for those who are deficient, not necessarily to enhance performance.
Munger emphasizes preventive strategies like a healthy diet, moderate alcohol intake, regular exercise, and maintaining a healthy weight to support overall hormonal health.
