Is Low T (Low Testosterone) a Myth?

Low testosterone, commonly referred to as Low T, is the term most people use for hypogonadism. Testosterone is an important hormone (produced in both men and women) that drives various bodily functions and traits, not least sexual desire and “manly” traits like muscle building and strength.

It’s worth noting that testosterone is also essential in women. However, they require about 1/10 of the testosterone that men do. Women with concerns revolving around testosterone can see a female urologic specialist or knowledgeable endocrinologist. For the purposes of this article, however, we will focus on male testosterone levels.

Is Low T A Myth?

If you believe the online and television ads about Low T, you might think this was an epidemic amongst American men. Indeed, men’s clinics, some unscrupulous, have thrived based on providing testosterone therapy for middle-aged and older men. But true hypogonadism is relatively rare, and most men who present with the symptoms of hypogonadism are more likely to benefit from lifestyle change than testosterone therapy. This is not to say that low testosterone doesn’t exist. Rather, we know it is not as prevalent as it may seem.

While replenishing a hormone the body produces anyway may seem a low-risk proposition, there are potentially significant side effects with testosterone replacement therapy if not administered appropriately. While most may think of a hyper-manly person with uncontrollable anger, this “roid rage” is rarely the result of TRT. Instead, very high doses of testosterone can cause increased viscosity of the blood, which can, in turn, lead to cardiovascular issues. They can also cause mood swings and unwelcome bodily changes.

Flaws in Measuring Testosterone

Any discussion on Low T must touch on how we don’t have a good baseline measurement of testosterone because there are so many variables, including age and lifestyle habits. Further, proper testosterone testing is performed multiple times as it can fluctuate throughout the day. Notably, many of the studies conducted to understand testosterone levels have used young, healthy patients as the baseline. We know that testosterone production slowly (and naturally) decreases with age, and as such, using this demographic as a benchmark for older patients’ testosterone levels isn’t appropriate.

With that said, let’s discuss the various claims surrounding low testosterone and see if they hold water.

Loss of Sexual Desire and Erectile Dysfunction.

Clinically low testosterone can indeed cause a drop in sexual desire, known as libido, and even lead to erectile dysfunction. However, is this caused by low testosterone alone? As we age, we start to lose vascular efficiency for several reasons. First is a general weakening of the heart. Also, no matter how healthy we’ve stayed, there is always some buildup of plaque in the arteries, which causes a restriction of blood flow to the penis and other structures of the body. Loss of desire can occur due to relationship issues and concerns or a lower priority placed on sex as we age. Ultimately, blaming it only on testosterone may miss the point unless all lifestyle habits have been considered and corrective changes have been implemented.

Weight Gain and Fat Accumulation

Testosterone can affect weight and fat accumulation; however, it is rarely only caused by testosterone levels. If you are eating healthily, restricting your calories appropriately, and exercising regularly while maintaining proper hydration, yet you are still gaining weight, this may be a good time to see your urologist or endocrinologist about a hormonal problem. However, if you have room to improve your lifestyle, be sure to do so to rule out variables and allow us to zero in on conditions like low testosterone. Even if you are found to have Low T, lifestyle change can make a significant difference in improving testosterone production, making testosterone therapy even more effective.

Building Muscle

Many patients with Low T cannot build muscle how they want or are used to. Of course, there is also the possibility and likelihood that patients are not working out as much or as intensely as they could. Or, if they are, their lack of muscle growth may be due to age and a decrease in ability, often caused by the vascular restriction mentioned above. Patients should ensure they are performing appropriately for their age before looking to testosterone replacement as an option.

Natural Testosterone Boosters

With all the above said, we can’t stress enough that patient should improve their lifestyles to see if their mood and abilities improve.

• Quitting smoking is an essential part of this continuum. In addition to the increased risk of cancer, smoking constricts blood vessels, which could lead to many of the symptoms commonly associated with Low T.
• Diet and exercise are also critical. Proper diet and regular exercise can assist men in losing weight and building muscle. Both allow for more efficient testosterone production later in life. A sedentary lifestyle and a poor diet high in saturated fats, simple carbs, and sugars can suppress testosterone production.
• Proper sleep. Most Americans do not get enough sleep; even if they do, it’s often poor-quality sleep. Proper sleep hygiene, including shutting down devices well before bed, keeping the bedroom dark and cold, and more, helps improve testosterone levels.
• Hydration is vital to testosterone production and overall well-being. A seemingly minuscule 1-2% hydration deficit can cause significant physical and psychological concerns. Most patients should drink at least 64 ounces of water per day.

As you can see, physical and mental health can be a significant factor in testosterone production. This is not to say that testosterone replacement isn’t necessary for some people who have true hypogonadism, but for most, avoiding unscrupulous health clinics and speaking to a knowledgeable urologist or endocrinologist is the best way to understand whether Low T is a problem or if there are other factors at play.

Schedule a visit with Dr. Engel to understand how to improve your physical and psychological acumen in middle age and beyond.