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Testosterone 101: Miriam Hospital Experts Set the Record Straight

6/10/2013

June 10-16 is National Men’s Health Week  


To some men, testosterone is an athletic performance booster, while others see it as a “miracle drug” that can improve your sex drive and make you feel younger. According to experts at the Men’s Health Center at The Miriam Hospital, there are conflicting messages about testosterone and testosterone treatment, making it tough for men to separate fact from fiction.

Martin Miner, M.D., co-director of the Men’s Health Center at The Miriam Hospital, says testosterone is a hormone naturally produced by men that helps regulate bone density, fat distribution, muscle strength, red blood cell production, sex drive and sperm production. Testosterone levels gradually decrease as men age, which can cause symptoms such as erectile dysfunction, depression, lack of energy and low libido – symptoms that also mimic the signs of aging.

A 2010 study in the New England Journal of Medicine warned that only about 2 percent of men older than 40 have clinically defined low testosterone levels. However, recent research suggests testosterone replacement therapy prescriptions have tripled among middle-aged men. Yet how many of them really need it? Miner examines some of the most common myths about this male hormone.

Myth No.1: Testosterone is only used to improve sexual function or build muscle.

When it comes to building muscle, men with normal testosterone levels who use synthetic testosterone – which has been banned in professional sports – in hopes of getting a performance boost are putting themselves at risk for heart disease, stroke, impotence and other dangerous side effects, Miner says, which is why is it not prescribed for men simply looking to bulk up.

While it is true that testosterone does improve sexual function, it can also improve a man’s overall metabolic health. “Testosterone levels are connected to a man’s waist circumference, so basically the lower the testosterone level, the larger his waist circumference and belly fat – and the higher his blood sugar and blood pressure become. This can all lead to metabolic syndrome, or pre-diabetes,” says Miner. Left untreated, metabolic syndrome not only increases the risk for heart attacks and strokes, but it can also lead to type 2 diabetes.

However, several studies have shown that treating low testosterone with hormone replacement therapy – combined with diet and exercise changes – reduces overall fat mass and improves both lean body mass and bone strength, potentially reduces the risk of heart attack and stroke and thwarts the development of type 2 diabetes.

“These are some of the non-sexual reasons that we are giving testosterone therapy, although we do not simply prescribe testosterone for these reasons alone,” says Miner. “We prescribe it to men with documented low testosterone and signs and symptoms of testosterone deficiency. However, we do incorporate these novel findings into our thinking.”

Myth No. 2: Testosterone causes prostate cancer.

Miner says this is false … mostly. While prostate cancer is still listed in the product insert for testosterone replacement treatment as a possible risk, it is based on single study in the 1940s with only three men. This long-standing fear about testosterone and prostate cancer held up for decades, but Miner stresses that it is without any scientific support and there is no evidence to date that testosterone therapy causes or stimulates the growth of new or pre-existing cancers in the prostate gland.

The caveat, however, is men with metastatic prostate cancer, or cancer that has spread outside the prostate gland. Miner says in these cases, testosterone therapy should not be given, as it might increase the risk that residual cancer will again start to grow.

Myth No. 3: You don’t really need a doctor’s prescription; it’s safe to purchase testosterone replacement products on the Internet, at specialty clinics or over-the-counter at health and nutrition stores.

Turn on late night television, and you’ll be bombarded with ads for testosterone-like products that claim to enhance sexual potency, desire and penile size. However, Miner says none of these have been found to work. In addition, “vitality centers” and testosterone therapy clinics have been springing up around the country, catering to men who are looking to feel younger, get buff or boost their sexual desire.

Miner says these sources of testosterone can be potentially dangerous for several reasons. Some of the physicians dispensing treatment are not trained in hormone therapy and may miss underlying problems. Also, extra testosterone can cause blood clots and harmful thickening of the blood that could lead to a condition known as thrombocytosis, which is a potential cause of heart attacks, stroke and peripheral vascular disease. Testosterone abuse can also increase the risk of prolonged testosterone deficiency, breast enlargement in men and infertility.

“Most importantly, the only men who should be treated with testosterone replacement therapy are those who have had a full exam by their doctor, discussed any symptoms they may be experiencing that could indicate low testosterone and have had that diagnosis confirmed with a blood test,” says Miner.