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04 Jul 2014 00:00
For decades, testosterone was associated with bodybuilders; now it is marketed as a way to slow aging. (Getty)
Middle-aged women the world over are ... chuckling.
At least I imagine they are, given the recent news that testosterone supplementation may increase the risk of heart disease.
It’s the kind of convoluted, premature scientific conclusion about hormone replacement therapy (HRT) that women have endured for at least 35 years. Take oestrogen and avoid hot flashes, weight gain and depression! No! It will give you cancer if you don’t take it with progesterone! Oh, go ahead – just take both!
It’s enough to send you to the Zoloft.
Until recently, men had largely been spared this anxiety. For decades, testosterone – T – was consigned to the bodybuilder/baseball felon crowd; if you admitted to its use you were officially “icky”. No one wanted to look like Saggy Schwartzenegger does these days.
Then there was the ever-lurking, ill-defined risk that T “caused” cancer (testosterone being a growth factor and cancer being a disease of unregulated growth).
And, even as new studies indicated that its cancer risk was almost non-existent (unless you already had it), establishment medicine blinked when it came to prescribing T for men. That’s because most general practitioners have almost no training in endocrinology and hormones.
As one physician pointed out to me while I worked on a book on the subject: “Most of us have opinions about testosterone that are based on 50-year-old studies that have no validity today.”
Yet, as the baby boomers aged – and got fed up with establishment medicine – T began to look better and better; they soon found a new source of hope: anti-aging doctors. Those ever-enterprising folk had no problem with prescribing testosterone cream.
Sales went through the roof. Suddenly, for men, 60 was the new 16! Now enter the genius of mainstream pharmaceutical marketing. As it did with Viagra and erectile dysfunction, the industry funded studies that got low-T reclassified as a legitimate medical condition. The Food and Drug Administration approved. Sales of under-arm T now tops sales of Viagra.
Now men are entering the HRT vortex. Just like our sisters.
I’m not against T supplementation. I use it in low-dose form and it has helped with post-concussion issues such as jumpiness, muscle loss and fatigue. But it’s hardly a panacea for the aging male. It’s just a more comfortable way to slide into your golden years, just as HRT is for women.
But, like any other drug, deciding who should take it is unclear at best.
You wouldn’t know it from hysterical “health news” sites, but low T is associated with all kinds of bad things in aging: it can speed cognitive decline, impair muscle maintenance, lead to higher fasting sugar levels and, yes, higher risk factors for heart disease.
But, surprise, as with all hormone use, the results of testosterone supplementation can be highly idio-syncratic and, in the longer term, double-edged. What works for one person doesn’t work for others, and what seems to be beneficial often comes with an unanticipated downside.
When I first began using testosterone cream I was concerned about my “bad” cholesterol levels; they topped 200. “Oh, that number is going to get so much better,” my anti-aging doctor said. “Just wait for the next test. It will blow your mind.” Sure enough, in the next test that number, which had been stable for many years, was down a full 30 points. Awesome!
Then I looked down the test report columns and found something unexpected: my “good” cholesterol was also down. Why? Does the same T-driven mechanism that makes the liver “eat up” bad cholesterol also eat up the good stuff?
There are also other less “medical” concerns. If you get too much T for too long, you may begin to get “moobs” – man boobs. That’s because excess T turns into oestrogen. Awesome – if you’ve got a good tailor or are totally into letting your buddies pinch you there.
Then again, an article in Aging Male indicates that T might help to prevent “age-related penile remodelling”. In rats. And, according to Andrologia, you might be able to get the same effect using a “natural” supplement made out of Eurycoma longifolia, a flowering plant from Indonesia.
Yet, in this month’s Endocrinology, we learn that: “Testosterone replacement ameliorates nonalcoholic fatty liver disease in castrated male rats.”
But now I’m confusing you. I mean, what should a man do? Supplement or not? It’s something to discuss with your doctor … or not.
Greg Critser is the author of Fat Land, about obesity, Generation Rx, about drug companies, and Eternity Soup, about aging
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