As with women’s hormones, there are many misconceptions and myths when it comes to men’s hormones. Women have an obvious marker of hormone decline when their menstrual cycles begin to change and eventually stop all together. For men, the changes in their hormones are often more subtle and less specific, leaving room for confusion, misdiagnosis and lack of treatment. Though not a myth, the first misconception about men’s hormones is the lack of understanding of the symptoms of testosterone decline and the incredible prevalence with which it happens. Studies indicate that nearly 40% of men over the age of 45 have overtly low testosterone levels. Recent pharmaceutical advertising campaigns have brought this subject some much needed attention, although there are still many common misconceptions when it comes to testosterone and men’s health.
Myth #1: The primary symptom of low testosterone is erectile dysfunction or low libido.
FALSE: Though low or suboptimal testosterone levels can contribute to changes in libido and the ability to achieve or maintain an erection, symptoms are varied and often include fatigue, apathy, difficulty concentrating, weight gain, depression, sleep disturbances and, most importantly, changes in metabolism including an increased risk for metabolic and cardiovascular disease.
Myth #2: Testosterone replacement increases risk of adverse cardiovascular events.
FALSE: There were two articles published at the end of 2013 and in the early part of 2014 which purported that men on testosterone supplementation had an increased risk of heart attack, however neither of these studies was particularly well run. They were both observational and retrospective, which severely limits the ability to control variables and is not sufficient to establish causation. Furthermore, one of the studies found that the mean level of men who were ON SUPPLEMENTATION was still only 332 ng/dL, and nearly 40% of the cases didn’t even have post therapy levels measured. While there is no agreed upon “low” for serum testosterone levels, most labs have a reference range that goes from approximately 300-1100 ng/dL, so a measurement of 332 is quite low. Conversely there exists a multitude of studies that link LOW testosterone to increased cardiovascular disease, and furthermore that testosterone replacement improves cardiovascular and metabolic markers. The NIH conducted one of these studies for the express purpose of investigating the findings of the JAMA study that linked testosterone replacement to increased risk. This follow up study looked at over 24,000 patients and found no increased risk of heart attack in those treated with testosterone.
Myth #3: Men should only be treated with testosterone if their measured levels are overtly low.
FALSE: As is typical with laboratory medicine, the reference range parameters don’t always equate with the optimal clinical outcomes. Studies indicate that men who maintain their testosterone levels in the mid to upper range have reduced incidence of cardiovascular events compared with those in the overtly low, or high ranges. The threshold of benefit appears to be greatest when levels are maintained above 500 ng/dL in serum.
Myth #4: Testosterone supplementation causes or contributes to prostate cancer.
FALSE: In the 1940s it was observed that castration reduced the incidence of prostate cancer. From this observation, it was extrapolated that testosterone must play a role in the pathophysiology of prostate cancer. The testicle produces several hormones other than testosterone, and it is now believed that the improvement seen in those patients was due to a decrease in estrogen production rather than testosterone. Prostate cancer is uncommon in young men, who generally have higher levels of testosterone, and becomes more prevalent with age, as testosterone levels fall. Over the past decade or so, there have been many investigations that have disproven the link between testosterone and prostate cancer.
Myth #5: The only way to increase testosterone levels is with hormone replacement.
FALSE: Though testosterone replacement can be a very powerful and effective treatment, there are many natural ways to boost endogenous testosterone production. For many men, weight loss will go a long way to boost testosterone levels. This is further improved with the building of muscle mass, therefore weight or resistance training is highly recommended. Short term, moderate intensity endurance training can also significantly increase testosterone levels. There are several nutritional and herbal supplements that improve testosterone levels including zinc, Tribulus terrestris, and Epimedium grandiflorum. Additionally, supplementation with DHEA, a hormonal precursor to testosterone can be effective in many cases.