A 50-year-old guy goes to the doctor with the symptoms of, well, being a 50-year-old guy.\u00a0 He\u2019s overweight, sleeps poorly, and has less energy, as well as a lot less sex, than he once did \u2013 and all of this has made him depressed.\u00a0 Blood is drawn and his testosterone level is normal but on the low side.\u00a0 Doctor\u2019s orders:\u00a0 Join a gym.\u00a0 Lose Weight.\u00a0 Eat better.<\/p>\n
This confounds Tim Church, M.D., a preventive medicine researcher in Dallas.\u00a0 That\u2019s because he knows from experience how few fatigued, out-of-shape guys actually succeed trying to follow that common-sense advice.\u00a0 \u201cIf we just tell him to go to the gym, it\u2019s almost guaranteeing failure,\u201d Church says.\u00a0 \u201cWhy wouldn\u2019t we give him something to help?\u201d<\/p>\n
For a growing number of physicians, that something is testosterone.\u00a0 The hormone, of course, has long been prescribed to men whose levels drop below normal (and has been doled out haphazardly by low-rent doctors, giving it a bad reputation).\u00a0 But a new wave of sophisticated anti-aging specialists are deploying T in a different way, as a kind of jump start designed to spur lifestyle changes\u2014even if a patient\u2019s levels fall within the normal range.<\/p>\n
\u201cI\u2019ve seen an uptick in my practice,\u201d says Joseph Raffaele, M.D., an age-management doctor who runs a boutique clinic in New York City.\u00a0 Give lethargic, depressed, or low-libido guys a jolt of \u201cT\u201d, Raffaele says, and they are more likely to make it to the gym.\u00a0 That begets increased muscle mass and fat loss, which increases natural testosterone production.\u00a0 In other words, a boost of testosterone triggers a virtuous cycle that can give men a second chance at younger years.<\/p>\n
Not only that.\u00a0 \u201cThey lose fat around the middle and all their numbers improve\u2014blood pressure, cholesterol,\u201d Raffaele says. \u00a0\u201cAll the things doctors worry about for patients in their 40s and 50s.\u201d<\/p>\n
This thinking represents a sharp break from conventional medicine.\u00a0 Yes, testosterone affects a range of bodily functions, including mood, red blood cell production, muscle growth, bone density, and sexual arousal.\u00a0 But the hormone hasn\u2019t been considered a cure for aging.\u00a0 Frances Hayes, M.D., an endocrinologist at Massachusetts General Hospital in Boston and a leading authority on hypogonadism (clinically low testosterone) hasn\u2019t seen evidence that treating a guy whose T is on the low side of normal translates into any life-changing vitality.\u00a0 (The numbers vary depending on the lab doing the testing, but the normal range for a guy 19 to 39 years old is 264 to 916 ng\/dL.)\u00a0 According to Hayes, even men whose testosterone levels fall in the just-below-normal range can expect mediocre results.\u00a0 \u201cI\u2019ve had plenty of patients who say to me that they don\u2019t have the energy to go to the gym,\u201d she says.\u00a0 \u201cIn my experience, when we bring their testosterone levels up, they still don\u2019t seem to have the energy.\u201d<\/p>\n
Hayes, like most of her endocrinology peers, argues the better, safer way to boost T for a guy with the middle-age blues is the classic prescription of weight loss, de-stressing, and eating well.\u00a0 To wit:\u00a0 A 2017 study published in the Journal of Clinical Endocrinology and Metabolism shows that dropping 10 percent of your body weight can translate to an 80-point bump in testosterone.<\/strong><\/p><\/blockquote>\n
Both sides of the debate were looking for clarity from a first-of-its-kind study funded by the National Institute of Health.\u00a0 The T trials followed 790 men ages 65 and older with below-normal testosterone for one year.<\/p>\n
The results, released this year, were a mixed bag.\u00a0 Testosterone scored points for improving erections, sexual frequency, anemia, and bone density.\u00a0 It didn\u2019t improve cognitive performance (the brain, like the rest of the body, is loaded with testosterone receptors, so it was an attractive theory), and the mood boost was marginal.<\/strong><\/p><\/blockquote>\n
Some of the researchers were surprised that added testosterone didn\u2019t boost energy.\u00a0 They had used a standard gerontology measure:\u00a0 how fast the seniors stood, then how far they walked or jogged in six minutes.\u00a0 Those on T outperformed the placebo group but only barely.<\/p>\n
\u201cThat\u2019s one of the things that\u2019s really perplexing,\u201d says Shalender Bhasin, M.D., an endocrinologist at Brigham and Women\u2019s Hospital in Boston, who worked on the trials.\u00a0 \u201cDespite clear evidence of testosterone\u2019s effect on muscle mass and strength, why has the improvement in physical function been so difficult to demonstrate?\u201d<\/p>\n
Raffaele us unfazed by the results, point out that the men in the study are considerably older than the patients he sees.\u00a0 \u201cFor these men, the horse is already out of the barn,\u201d he says.\u00a0 \u201cThe researchers are trying to intervene in the aging process 20 years too late.\u201d<\/p>\n
Until there\u2019s a multiyear study on younger men, those who opt for treatment accept an element of guinea pig status.\u00a0 Doctors are particularly concerned with potential heart problems; in 2015, the FDA required testosterone labeling to include a warning about a possible increased cardiovascular risk.\u00a0 It also may be linked to sleep apnea, stimulating noncancerous prostate growth and blood clots, among other things, says Debabrata Mukherjee, M.D., the chief of cardiovascular medicine at the University of Texas Medical Center of El Paso in Texas.<\/p>\n
And it\u2019s expensive.\u00a0 Unless you\u2019re technically hypogonadal, insurance won\u2019t cover it, so men must pay somewhere $50 to $200 a month for treatments, not including initial testing fees.<\/p>\n
Critics contend the pro-T doctors have chosen the wrong enemy:\u00a0 aging itself.<\/p>\n
\u201cHormones serve an evolutionary purpose and the drop may be normal,\u201d says Darby Saxbe, a clinical psychologist at the University of Southern California.\u00a0 Testosterone peaks in a man\u2019s 20s\u2014prime mating years\u2014then goes on a long, slow decline.\u00a0 Her research found that a man\u2019s testosterone decreases if his partner is pregnant; the more children he has, the lower it is.\u00a0 Coincidentally, men with lower testosterone are more attentive fathers and better partners.\u00a0 In middle age, maybe you\u2019re not supposed to be sowing your wild oats.<\/p>\n
Yet the anti-aging movement exists to defy evolutionary decline.\u00a0 Raffaele is comfortable boosting the T levels of his patients to those of men half their age.\u00a0 After all, he says, \u201cWho doesn\u2019t want to feel like a 20-year-old?\u201d<\/strong><\/p><\/blockquote>\n
Plus, if testosterone treatment does spur healthy changes, men may avoid or delay some age-related diseases.\u00a0 Shedding weight and boosting happiness, for example, are great for the heart.\u00a0 And the effects may be fairly direct.\u00a0 Brent Muhlestein, M.D., a cardiovascular researcher in Salt Lake City, used patient data from the Intermountain Medical Center to complete two observational studies.\u00a0 They revealed that older, low-testosterone patients who had undergone T therapy suffered fewer heart attacks and strokes.\u00a0 \u201cIf placebo-controlled trials confirm those positive results,\u201d Muhlestein says, \u201cthen we\u2019ll use testosterone as a drug to treat our heart disease patients.\u201d<\/p>\n
The Endocrine Society is set to release new guidelines for testosterone in 2018.\u00a0 The safe money says it\u2019s not going to widen the T-treatment threshold, which will keep the anti-aging doctors outside the medical mainstream for now.\u00a0 But that won\u2019t stop plenty of guys who aren\u2019t giving up on feeling young.<\/p>\n
Reprinted from Men\u2019s Health magazine<\/p>\n
Read more in our\u00a0Low T\u00a0Health Center<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"
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