Could It Be Low T?

Hormone replacement therapy for men carries benefits and risks

In the last few years, Stephen Willis has talked to more and more patients about the hormone that, physically speaking, makes men be men: testosterone.

It deepens the voice, grows the beard and puts on muscle. It stimulates the sex drive. But after age 30, testosterone levels start a downward trek. Though “T” decreases by only about 1 percent a year, over a couple of decades… well, a lot of testosterone is just not there anymore. And that’s what worries Willis’s patients.

“Some men are going to want to have high levels of testosterone in their fifties because they want to feel better,” says Willis, a local physician assistant with Rockwood Clinic who specializes in endocrinology and men’s health.

Ten years ago many men probably would have Low T treatments include Axiron and Depo-Testosterone. tacked up symptoms such as fatigue and loss of sex drive to getting older. Now they’re looking for answers.

It’s another symptom of what was once an accepted part of aging now becoming something that’s “curable.” And you can hardly blame guys — “old” age goes on a lot longer than it did in the past. According to the National Institute on Aging, just 50 years ago the average American could expect to live to 70. Now it’s nearly 80.

Of course, spurring that search for answers is a slew of ads. Unless you’ve just popped out from under a rock, you’ve seen them, with their sly warnings: “It could be Low T…”

As a result, prescriptions have nearly doubled over the past five years, according to IMS Health, a global health firm that specializes in technology based analysis. IMS Health also found that in 2011, sales hit $1.9 billion worldwide.

It would be easy to ascribe the interest in testosterone therapy to a marketing drive, but it is a tangled issue.

Low testosterone levels are a real medical condition, and not always just a result of aging; but, while there’s fairly general agreement on what constitutes a low level in younger men, it’s been difficult to determine guidelines for what determines a “low” level in an older male. Complicating things is the fact that testosterone levels can vary substantially throughout the day, meaning a blood test in the morning may be very different from one in the afternoon, or from day to day. And just because testosterone levels are low doesn’t mean men should reach for a replacement hormone.

“Quite often … men have low testosterone levels because of sleep apnea, depression, alcohol and substance abuse,” Willis says. Being overweight can also affect T levels.

If these underlying issues are treated, Willis says testosterone levels often naturally rise to a normal level. For the men who still do need treatment, “there’s risk,” he says. “It can cause an increased risk of blood clots and prostate cancer. Cholesterol levels can go up.”

Androgel, the most commonly prescribed testosterone, was forced to provide a black box warning label after children who came in contact with it had adverse side effects.

Dr. Mihai Alexianu practices at Spokane Urology, where he says just a handful out of the up to 100 patients he sees a month seek testosterone therapy.

“It’s very effective” for those who need the treatment, he says. “The question is how safe it is because it is associated with increased risk of urinary obstruction, BPH [or benign prostatic hyperplasia] and prostate cancer. Some people have significant side effects.”

And for men who aren’t undeniably testosteronedeficient, treatment may not be effective.

“The problem is that we don’t have any evidence that prescribing testosterone to older men with relatively low testosterone levels does any good,” said Dr. Sergei Romashkan in a recent Associated Press article. Romashkan works for the National Institute on Aging overseeing clinical trials. He is currently conducting a trial of 800 men over the age of 65 to “definitively” determine whether testosterone therapy improves a man’s ability to walk, his sexual function and his energy, among other things. Stay tuned. The results are due in 2014.

Perplexed By Testosterone

Researchers have been concerned that T levels are falling in men in industrialized countries. However, studies of men in unindustrialized groups have revealed low levels of circulating testosterone. Why? High levels of testosterone seem to compromise the body’s ability to mobilize the immune system. In areas rife with parasites and disease, lower testosterone levels foster the ability to battle these bodily invaders. UW researcher Ben Trumble and colleagues studied an isolated Bolivian tribe — the Tsimane — where T levels were markedly lower than in the average American male. Still, in their study published in March 2012, they found that a competitive game of soccer sent testosterone levels soaring, just as sports do among American men, with elevated levels persisting at least an hour after the game. Though levels rose in winners and losers, the most virile responses were seen in individuals who felt they had played especially well.

— Anne McGregor

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About The Author

Nicholas Deshais

Nicholas Deshais is the Editor of the Inlander, where he oversees the entire editorial operation and supervises news coverage. He was a staff writer for the paper from 2008-12, and has worked for various news outlets, including Portland’s newsweekly Willamette Week, the Spokesman-Review, Northwest Public Broadcasting...