Note: The treatments described in this article are for providing medical information but this is not medical advice. While there are studies that support the treatments described, the treatments are considered experimental and not the standard of care. For medical guidance you should contact your physician or health care professional.
Testosterone is the primary male sex hormone, responsible for male sexual development and critical in maintaining your erectile function, libido, normal energy levels and mood. Testosterone also controls a whole range of physiological functions throughout the body. As you reach your 40s, your testosterone levels begin to decline. This decline leads to a reduction in your energy and a slowing of metabolism. Thus, it is very common for you to develop a paunch in your 40s and 50s. This reflects the weight gain that occurs with decreased metabolism.
Multiple studies have shown cardiac benefit from testosterone replacement. Testosterone can improve lipids, raising the good HDL cholesterol while lowering the bad LDL cholesterol. Testosterone improves your metabolism and reduces your visceral fat. By reducing your visceral fat, insulin resistance starts to decrease, and that vicious cycle starts to get reversed. Testosterone starts to eat away at your visceral fat and converts your fat to muscle. This cardiac benefit is why testosterone replacement can save your life.
When men have increased fat, a vicious cycle is started. The increased visceral fat leads to insulin resistance. Thus, there is increased insulin circulating. The insulin leads to increased appetite and increased fat storage. As your fat increases, your insulin resistance worsens and your testosterone level falls further, both of which lead to further increased fat. Testosterone helps break this vicious cycle. Multiple studies have shown that testosterone can improve insulin resistance and significantly improve diabetes mellitus. Thus, any man with diabetes mellitus should determine if he is a candidate for testosterone replacement.
Testosterone has all these benefits including weight loss, improved mood, increased energy, improved cardiac health, improved bone density, increased muscle mass, decreased visceral fat and reduced insulin resistance. Despite all these benefits, many physicians are often reluctant to recommend testosterone. This is because of misconceptions about testosterone. Today I am going to address two of the most common misconceptions about testosterone use.
Testosterone increases the red blood cell count in circulation. In medical terms this means that there is an elevated hemoglobin and elevated hematocrit. This is an adaptive response to increased oxygen utilization. Other conditions with a similar adaptive response include emphysema and living at high altitude. This occurs with emphysema because of oxygen deprivation, so more red blood cells are formed to deliver more oxygen. Similarly, at high altitude there is lower oxygen concentration, which is compensated for by the increase in red blood cells. With testosterone, there is increased oxygen utilization so more red blood cells are needed to meet this increased demand. Thus, the increased red blood cells is an adaptive physiologic response to testosterone and is not a side effect or adverse reaction.
The misconception is that the increased blood count would make a blood clot more likely. This is concerning because blood clots are responsible for heart attacks and many strokes. Some are concerned that the increased blood count leads to a thickening of the blood, which creates the environment for clots to form. Fortunately, many studies have established that testosterone does not increase the risk of clots. Even among high-risk patients, it was shown that those men who took testosterone have less cardiac events than men who did not take testosterone (the Intermountain study, 2015). There is a condition called polycythemia vera in which the red blood cell count is elevated and those patients are at risk. However, in this condition the platelets are also elevated and these increased platelets create the risk for the clots. If you understand the difference between polycythemia vera, which increases the risk from clots, and the elevated red blood cells that occurs as a physiologic response to testosterone and does not increase the risk of clots, you know more about this than most physicians.
Another misconception is that testosterone causes prostate cancer. This idea started in the 1950s when testosterone as a potential therapeutic input was first described. It was not based on any studies but was just proposed because testosterone is the male hormone and the prostate is a male organ. Thus, there was concern that the prostate would be overstimulated by testosterone, which could lead to prostate cancer. Fortunately, dozens of studies over the past few decades have shown that testosterone does not cause prostate cancer.
One reason that so many doctors think that testosterone causes prostate cancer is that when a man is diagnosed with prostate cancer, part of the treatment includes suppressing testosterone production to bring the testosterone level down to zero. To clarify, testosterone does not cause prostate cancer, but if prostate cancer is present, testosterone can stimulate that cancer. However, it is important to understand that testosterone will stimulate that cancer even if it is at a very low level. In other words, testosterone will stimulate that tumor even if one does not take testosterone.
It is important to understand that a key risk factor for cancer growth is increased visceral fat. This is the fat around organs and is very dangerous because it leads to inflammation in the body. Inflammation creates the ideal environment for many chronic illnesses including heart disease, stroke and cancer. Testosterone is invaluable for reducing visceral fat as testosterone helps convert fat to muscle. By reducing visceral fat, testosterone can reduce the risk of some cancers. Prostate cancer is graded in severity by a Gleason score. The higher Gleason score, the more advanced the prostate cancer. Interestingly, a study showed that the higher the testosterone level the lower the Gleason score. In other words, men who had lower testosterone levels had more advanced prostate cancers compared to those with higher testosterone levels. Furthermore, studies show that those with cured prostate cancer (PSA less than 1) who take testosterone replacement get the benefits of testosterone with reduction of cardiac risk and no increased cancer risk.
In summary, testosterone has a myriad of benefits including weight loss, improved mood, improved cardiac health, increased bone density, increased muscle mass, decreased visceral fat, improved sexual function and reduced insulin resistance. Despite all these benefits, there are several misconceptions in the medical community that serve as barriers that discourage physicians from recommending testosterone. I have shown why these misconceptions are incorrect and should not deter any eligible male from realizing the benefits of testosterone replacement.
Dr. Slaten is a wellness physician specializing in regenerative pain treatments and lifestyle counseling. He is certified in advanced bioidentical hormone replacement. You can learn more at his website: www.hormonesnj.com or call Dr. Slaten at (201)882-1500.
