It’s nearly impossible to get through watching a ballgame on TV or a drive listening to sports radio without ads for men’s health medication — pills that do this; creams that do that — sometimes for conditions you may have never heard of, like low testosterone, commonly called Low T. So is Low T therapy for real? Should it be on your mind? We asked OhioHealth urologist Gregory Lowe, MD, all about it.What is low testosterone?
What is low testosterone?
Testosterone is what we think of as the “male” hormone (estrogen being the “female” hormone, though men and women produce a little of the other). Testosterone plays a big role in male physical and sexual development, as well as physical, sexual and even mental performance. A blood test can measure testosterone—levels below 300ng per deciliter put you in Low T territory. Dr. Lowe says Low T can be result of a negative cycle: You don’t work out, you gain belly fat, you have a decrease in testosterone, you stop working out, and so on. Testosterone therapy can help jump start a positive cycle.
“Testosterone drops as men age, about 1 percent a year after you turn 30, but that decrease normally doesn’t lead to Low T,” says Dr. Lowe, “Having low T is not part of aging—it’s not normal to have symptoms resulting from the decrease.” Dr. Lowe says those symptoms can include fatigue, lack of desire, worsening erections, inability to concentrate, issues with memory and diminished recovery from workouts, “but these symptoms do not mean that you have Low T, and also you can have Low T without experiencing these symptoms. If men have concerns, we can test to determine whether testosterone is the cause.”
What is involved in Low T therapy?
“From the medication side there are several options,” says Dr. Lowe, “A medication called clomiphene can be used if men are concerned with fertility. If they’re past that stage in life, there are a variety of testosterone patches, injections and gels… these therapies increase your level of bioavailable testosterone, or testosterone within the body that can alleviate your symptoms. Each option has different levels of effectiveness and cost that doctors and their patients can consider.”
But, Dr. Lowe stresses, effective Low T therapy does not involve medication alone. “We look for lifestyle changes in everyone—cardiovascular and strength training, weight loss, diet, finding healthy ways to deal with stress … It’s important to understand that testosterone therapy doesn’t prevent life from happening. You have to address issues in your life that may drive your symptoms.”
What are the misconceptions about Low T therapy?
When advertising around a therapy ramps up, so can misunderstandings about what these medications do. For example, Dr. Lowe explains, testosterone is not the fountain of youth. “Testosterone is not physically doing anything to stop the aging process. It can alleviate conditions we associate with aging, like fatigue, loss of muscle mass, loss of concentration. But it’s not going to work if you don’t put in the work. It’s not going to give you muscle mass without any effort.”
Where should men start if they have questions about Low T and their health?
Men with Low T generally end up under the care of a urologist, but Dr. Lowe says, for patients with questions about testosterone, the best place to start is with a family physician. “Some men have questions from a workout perspective, who are concerned with losing physical performance. Others think that maybe testosterone therapy can address erectile dysfunction, but that’s not necessarily the case. It’s so important to discuss the symptoms with your primary care physician, because many of these symptoms have other causes: low thyroid, low vitamin D, anxiety and depression,” says Dr. Lowe.“ If Low T tests come back and your levels are normal, then you’ve already started a constructive conversation with your doctor that can move in other directions.”
It’s this complete approach to health that men may not find if they seek treatments at advertised Low T clinics that only offer injections or medication. “A lot of men do it: get injection therapy without medical guidance or discussion of lifestyle modification, or they get it from buddies or guys at the gym, and no one is looking out for them,” says Dr. Lowe. “If you’ve self-diagnosed, and what you have is not Low T, you may not be aware of the risks that come with testosterone use, or you could be taking therapies you don’t need while at the same time not addressing your real problem. You’re paying for insurance; use it! Get trusted therapies from a physician. Testosterone therapy may not solve all your problems, but if it’s going to work, you really need it do it the right way.”
If you have concerns about Low T, start a conversation with your primary care doctor. If you don’t have one, OhioHealth can help you find a physician near you.