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Examiner
  • Lori Boyajian-O'Neill: What is 'low T,' and should you be concerned?

  • Testosterone, the primary male hormone, is regulated by the brain and manufactured in the testes.  It is the focus of an increasing number of advertisements for replacement therapy. Who needs it? What does it do? Testosterone, what do you know, T or F?

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  • Testosterone, the primary male hormone, is regulated by the brain and manufactured in the testes.  It is the focus of an increasing number of advertisements for replacement therapy. Who needs it? What does it do? Testosterone, what do you know, T or F?
    1. Most men have low T after age 40.  
    2. Low T is diagnosed with a blood test.
    3. Testosterone is manufactured in the brain.
    Hypogonadism is the medical term for abnormally low testosterone. The pituitary gland in the brain signals the testes to manufacture testosterone. Any breakdown in function leads to decreased testosterone production and hypogonadism.  
    No guy wants to admit to “low gonad levels” so the term “low T” has caught on and men are listening. Supplement manufacturers, pharmaceutical companies and clinics have seized on this with a blitzkrieg of TV commercials. It has worked. Sales of testosterone supplements have soared over 500 percent since 1993 as men seek the fountain of youth in testosterone replacement therapy.  
    Testosterone production peaks in late adolescence and early adulthood.  About age 30 levels start to decline at a rate of 1 percent per year.  About 25 percent of men over the age of 45 have low blood testosterone levels but absent symptoms, they may not have hypogonadism or low T.
    Testosterone maintains bone density, body fat distribution (think middle-age paunch), muscle strength and mass, red blood cell production, sex drive and sperm production.  Men with low blood levels of testosterone often complain about having poor energy, weakness and decreased sex drive. These symptoms may be due to hypogonadism or medical conditions such as diabetes, heart disease, sleep disorder, thyroid disease, depression and anxiety. Symptoms may also be from medication side effects, alcohol or illicit drug.  
    Many endocrinologists caution that jumping to the diagnosis of low T without comprehensive evaluation may be dangerous and lead to the wrong diagnosis and wrong treatment.  Are symptoms due to hypogonadism or a different condition? This the central question when considering the possibility of low T. Although testosterone levels decline as men age, it is not yet certain if this is detrimental to health.  
    Diagnosing low T is not as simple as getting a blood test.  A comprehensive medical history and medical interview followed by a complete physical examination and then blood tests should precede any diagnosis of low T. Individualized evaluation and workup are necessary for accurate diagnosis and treatment.  
    Testosterone replacement formulas come as injections, pellets, patches and gels.  A generation ago we simply did not have the widespread availability of testosterone replacement concoctions that we have today so the effects of long term use are not yet understood.   TRT is associated with sleep apnea, acne, enlarged breasts, limited sperm production, testicular shrinking, prostate enlargement and increased RBC production which may increase risk for stroke.
    For men with hypogonadism, TRT may lead to a higher quality of life.  Those taking testosterone supplements without comprehensive workup risk misdiagnosis, wrong treatment and severe complications.  Men beware.  
    Page 2 of 2 - Answers:  1. F;  2. F;  3. F.     
    Dr. Lori Boyajian-O’Neill can be contacted at lori.boyajian-oneill@hcahealthcare.com.
     
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