Testosterone Deficiency

Background

Just as it is normal for estrogen levels to drop in women, this is also common in males, and has been called "Andropause." Its significance goes well beyond erectile dysfunction.

Low testosterone is also associated with:

  • Depression and loss of motivation.
  • Elevated risk of high blood pressure, high cholesterol, weight gain and diabetes (called "metabolic syndrome").
  • Loss of muscle mass.
  • Increased risk of Alzheimer's.

Testing for Low Testosterone

This is another case where some physicians don't understand the difference between a test's result being in the normal range vs. being healthy (see "The Problems with Lab Testing"). It is important to also check the free (not just total) testosterone.

Be sure that the normal ranges for the lab results are broken down by ten-year age groups: 31-40 years old, 41-50 years old, and so on. It is meaningless to have a normal range that includes 80 year-olds if you're 28. Low based on the normal range means you are in the lowest 2% of the population (e.g., under 200), which is horribly deficient. A better approach? If you are in the lowest 25% of the normal range (a testosterone level under 450) and have symptoms suggestive of low testosterone, a treatment trial may be warranted.

Treatment

For men under 50, it is often best to simply stimulate your body's own production of testosterone using a low dose of a medication called clomiphene (a "Clomiphene Stimulation Test" will tell you if this will work for you).

In men over 50, I recommend using topical testosterone creams or gels, applying 25-50 mg to the skin each morning. This is available from regular pharmacies (Fortesta, Androgel or Testim gel), but the form made by compounding pharmacies is much less expensive if you do not have prescription insurance. Be aware that if the skin where it is applied comes in contact with a woman's skin (e.g., after a hug or if you don't wash your hands after applying the cream), this can result in very high, undesirable and unsafe levels in that woman's body. Because of this, I prefer testosterone applied to the thighs (e.g., Fortesta or compounded)  instead of the chest and arms. And you should always be sure to wash your hands after applying the cream.

In case you’re thinking that maybe it would be good for your wife to get some of your testosterone to increase her libido, think twice:

  • In women, raising testosterone too high can increase diabetes risk (the opposite of in men).
  • If you raise her libido with your testosterone, she may have more sex — but it may not be with you.

So be careful to keep the gel on you!

More Information Online

Can Testosterone Be Good for You?

Contributor: 

Dr. Jacob Teitelbaum, MD

Jacob Teitelbaum, M.D. is a board certified internist and author of the popular free iPhone application “Cures A-Z,” which was ranked in the top 10 of all health/wellness downloads on iTunes. Dr. Teitelbaum is the author of the perennial bestseller From Fatigued to Fantastic! (Avery Penguin), which has sold over half a million copies; Pain Free 1-2-3 (McGraw-Hill); Three Steps to Happiness: Healing Through Joy (Deva Press); the Beat Sugar Addiction Now! series (Fair Winds Press);  Real Cause, Real Cure (Rodale Press); The Fatigue and Fibromyalgia Solution (Penguin/Avery); and his latest, The Complete Guide to Beating Sugar Addiction (Fair Winds Press, 2015).