Should the Modern Man Be Taking Testosterone?

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Testosterone deficiency is exceedingly less common than marketing campaigns and "you only think you feel fine" culture would have us believe.

By now you've likely seen the commercials. Fit-looking middle-age men telling you how they put on weight, had less energy, and were no longer the sexual tigers they were in their twenties -- until, that is, they started rubbing testosterone gel on their shoulder, upper arm, or abdomen.

Now they feel more like the men they used to be.

The commercials don't mention a 2009 study in the New England Journal of Medicinewherein a group of men ontestosterone replacement therapyhad more than four times the number of cardiovascular problems -- so many that the study had to be halted.

They also don't make clear how risky exposure to testosterone gel is for others -- female partners, children, even pets. The gel is actually notorious for transferring to others. It can cause excess hair to grow on women's faces and arms, deepen their voices, interrupt menstruation, and make them anxious and irritable. In children, exposure to testosterone gels and creams can cause premature puberty and aggression. And in pets, it can cause aggressive behavior and enlargement of the genitalia.

Commercials do mention other potential side-effects for the male user, calling them "rare," including swollen and painful breasts, blood clots in the legs, increased risk for prostate cancer, problems breathing during sleep (sleep apnea), change in the size and shape of the testicles, and a low sperm count.But you're not supposed to focus on the details. Instead, just think of the energy you'll have. The great sex you'll have. And the muscles. It will be a veritable second adolescence as your aging body bursts into new bloom.

Don't get me wrong. The medical experts interviewed for this article emphasized that low testosterone -- also known as hypogonadism or hypotestosteronemia -- is real for a slim percentage of men. They hastened to add, however, that a normal "T" level for one man may be low for another.

According to British Medical Journal (BMJ), the European Male Ageing Study has provided the best estimate of the prevalence of low T -- defined as a combination of sexual symptoms and measured testosterone level -- finding that only 0.1 percent of men in their forties, 0.6 percent in their fifties, 3.2 percent in their sixties, and 5.1 percent of men in their seventies would meet the criteria for the diagnosis.

Unlike menopause in women -- when estrogen levels plummet and stop almost completely --testosterone levels in men normally fall by only 1 to 2 percent per year after age 40.

"Low T" is anything but inevitable. BMJ's Drug and Therapeutics Bulletin says that around 80 percent of 60-year-old men, and half of those in their eighties, have testosterone levels within the normal range for younger men. It concluded, "The evidence that an age-related reduction in testosterone levels causes specific symptoms is weak."The Food and Drug Administration (FDA) meanwhile has not approved testosterone use to improve strength, athletic performance, physical appearance, or prevent aging. And a 2004 report from the Institute of Medicine ("Testosterone and Aging: Clinical Research Directions") called TRT for age-related testosterone decline a "scientifically unproven method."

Should the Modern Man Be Taking Testosterone?