The Wall Street Journal-20080117-The Doctor-s Office- A Decline in Testosterone May Give Rise to Many Ills- Online edition
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The Doctor's Office: A Decline in Testosterone May Give Rise to Many Ills; Online edition
My boyhood baseball hero "Goose" Gossage made it into the baseball Hall of Fame last week. His 98-mph fastball and 22-year career as a fearsome relief pitcher were achieved without the use of steroids. His best years were back in the '70s and early '80s when men were men and made their own testosterone naturally. But even the most macho among us face a decline in the quintessential male hormone as we age. Recent evidence points to a decline in testosterone levels in the general population of men, regardless of age.
A 20-year study of testosterone levels in men found that testosterone concentrations dropped about 1.2% per year, or about 17% overall, from 1987 to 2004. The downward trend was seen in both the population and in individuals over time.
What happened to our testosterone? Did the ballplayers siphon it off? Some theorize changes in the environment are responsible for the broad decline. A physician friend who works out regularly told me recently that he could really start to feel the effects of his age after he hit his 40s. The signs: Slower recovery from activity, less tolerance of long hours and less muscle flexibility.
Testosterone levels start to drop for most men in middle age. For those wanting to start their testosterone decline sooner than that, getting married may help.
Married men have lower testosterone levels than single guys. A recent study among the Ariaal people in Kenya showed that unmarried men had higher testosterone levels than men with a single wife. And men with two or more wives had even lower testosterone than those with one.
It's estimated that two million to four million American men have a significant testosterone deficiency and that less than 5% of them are getting treatment. That mirrors what I see in my own practice. Most men who might need treatment don't come in with any regularity. Overall, I'm probably not helping as many men with the problem as I need to.
Low testosterone may lead to loss of body hair, sleep disturbance, sweats, depression, impaired thinking, lower bone mass and strength, fatigue and weak bones. Some signs are more subtle. Decreases in sex drive, energy, motivation, initiative, aggressiveness and self- confidence are other signals. Testosterone levels can be measured with a blood test. It's best to have it done before 10 a.m. because levels fluctuate during the day.
I discovered one of my patients was low on testosterone after he fell during a minor mishap and unexpectedly broke his forearm. He turned out to have osteoporosis due to low testosterone. He developed type 2 diabetes around the same time. Adult onset diabetes in men is also associated with low testosterone.
Carrying extra weight around the middle and a drop in muscle mass were warning signals that became clear after the fact. Low testosterone levels are increasingly prevalent and often under diagnosed by the medical community. It's one of those chronic things that can drag on for years without much beyond vague symptoms that a guy might wonder about but not come in over. Doctors often overlook it because other important and more pressing health problems.
Some two in 10 men over the age of 60 are testosterone deficient. Still, many men aren't aware that their testosterone levels are low or that there's a treatment available if they have symptoms from a deficiency.
Most commonly, gels, patches or injections are given to correct the deficiency. There can be side effects such as acne and oily skin, increases in red blood cells that could be potentially harmful and, in a worse-case scenario, acceleration of prostate cancer growth if an undiagnosed tumor is present.
This is one situation where more of a medication isn't necessarily better and the levels of testosterone need to be monitored along with prostate exams, blood work for PSA testing, liver function testing and blood counts.
Men with erectile dysfunction should have their heart and their testosterone levels checked because there is much more at stake than just their sex life. ED is associated with heart disease, and the smallest arteries responsible for erections are often the first to clog. If you have ED and haven't had your heart checked, you should. If you have ED and your Viagra isn't working, you should have your testosterone levels checked.
Compared with our knowledge of estrogen replacement for menopausal women relatively little is known about the long-term effects of testosterone supplementation in men. There were years when estrogen replacement was commonly prescribed for women with the expectation that it was beneficial for all sorts of ills. When large clinical trials were done we found out that risks for breast cancer and heart problems were higher for women taking hormones and that some benefits were overstated.
One thing is certain: Testosterone is not a magic medicine that will halt aging.
Steroids should stay banned from baseball, but in medicine they have their place. Despite all the testosterone in the world I'm never going to get a hit off the Goose. Even if he is 56.
