Testosterone deficiency or a panacea for virility?

BY DR. DAVID LIPSCHITZ Modified: December 13, 2012 at 1:10 pm •  Published: December 17, 2012
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Thanks to a brilliant marketing campaign, there has been increased awareness among men of the condition of testosterone deficiency — or "Low T."

A number of young adults are wearing a Low T badge with pride to show off their newfound virility. At long last, they can blame their chronic fatigue, insomnia, poor work performance, depression and an evaporation of libido on low testosterone levels.

This new syndrome was not developed through the effort of brilliant scientists, but by the Eli Lilly and Co. as an attempt to let everyone know how widespread testosterone deficiency is among men from age 30 on. To make the problem easier to understand and by using a nationwide campaign blitz, "Low T" is now a familiar phrase. If you have it, you are part of the in crowd who hopes to be forever young. Numerous scholarly studies have shown that in men over 45, an average of 37 percent will have testosterone levels in the low normal, but not deficient, range.

Low testosterone does interfere with some critically important functions. The hormone is essential for the production of viable and healthy sperm — it plays a role in libido but not in becoming aroused or having an erection. It is not surprising then that a research study just published in the Annals of Internal Medicine showed that adding testosterone to the erectile dysfunction drug Viagra in men with low testosterone did not improve the quality of the erection in any way. Testosterone also is essential for strong, healthy muscles and bones, and when deficient, can lead to osteoporosis and weakness. These symptoms generally occur in men well beyond 75 and are much rarer in men in their 60s.

The nonspecific symptoms that have been ascribed, in part, to low testosterone include fatigue, reduced muscle mass and weakness, decreased sports performance, depression, increased body fat, decreased bone strength, loss of body hair, a need to shave less frequently and temporal crown baldness.

Whether in a doctor's office or at a Low T clinic, patients are begging for a testosterone shot, preferably combined with a vitamin B-12 injection, to boost vim and vigor.

Because so many of the symptoms of low testosterone are nonspecific and could be caused by stress, depression, sleep disorders and many other conditions, rushing to treat a younger patient with a testosterone injection or cream should be done with caution. Testosterone should not used as a panacea for more energy, better sleep habits or greater prowess on the tennis court or golf course. It should be used for the far more serious problems, such as infertility, muscle mass loss, osteoporosis and improving libido.

And testosterone is not without side effects. It can lead to prostate cancer and cause the prostate to enlarge, leading to symptoms of benign prostatic hypertrophy (BPH), which causes difficulty with voiding and emptying the bladder completely. Prior to initiating treatment with testosterone, the prostate-specific antigen (PSA) test should be measured and the patient examined to define the severity of BPH.

Therapy can be given as self-administered injections every two weeks. This is the safest approach, as the materials can easily be discarded to avoid contamination of others. There are testosterone creams available that are effective and easy to use but very expensive. And if a woman, child or pet comes in contact with cream, virilization can occur.

The most important positive results of treatment are improved libido, more muscle strength, less fatigue and less osteoporosis. And remember, there are significant side effects that include acne, hirsutism, male pattern baldness, seborrhea and breast soreness, priapism (a painful enlarged penis), bladder irritability, headache, virilization, liver damage and bleeding tendencies.

Sadly, hormone replacement, with testosterone for men and estrogen and progesterone for women, is not the fountain of youth. In the long term, side effects are more serious than any short-term benefit.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at: www.DrDavidHealth.com

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