Back when T Nation first launched, we actually ran articles about how to trick your regular doctor into prescribing you testosterone replacement therapy. See, back then, docs were reluctant to prescribe the hormone, even if you were running low.
Today, much has changed. You can even find "men's clinics" in the local strip mall. Still, there are a lot of myths and misconceptions about testosterone. Let's dispel a few of them right now.
Back in the 1940's, doctors didn't know much about prostate cancer (or any cancer, for that matter). However, they noted that men with metastatic prostate cancer lived a bit longer when they were castrated.
I should rephrase that. They noted that ONE man with metastatic prostate cancer lived longer when he was castrated (1). That's right, the effects of castration on one poor bastard's prostate cancer led several generations of doctors to assume that it was testosterone itself that promoted the disease. Mind bogging, isn't it?
The truth is, men with low testosterone don't have anything to fear from TRT (testosterone replacement therapy). It won't increase their risk of developing prostate cancer. Consider the analysis of more than a quarter of a million records of men in Sweden that was released at the annual meeting of the American Urological Association in San Diego, California in 2016.
The researchers found that men who'd been prescribed testosterone for longer than a year not only had no overall increased risk of prostate cancer, but their risk of aggressive disease had been reduced by 50 percent.
And this is only the most recent of many studies that squelch the myth that TRT causes prostate cancer. Researchers in the United Kingdom looked at 1400 men who had received testosterone replacement therapy for up to 20 years and they found only 14 cases of prostate cancer over the course of the study (2).
This prompted the co-author of the study, Dr. Malcolm Carruthers, medical director at the Center for Men's Health in London, to state:
"This myth about testosterone replacement therapy being linked to prostate cancer has been rooted deep in medical consciousness for over 60 years, but this paper says no. Testosterone treatment is actually good for the prostate, not bad."
It's long been thought by the general public that men with male pattern baldness have higher levels of testosterone than their well-coiffed counterparts. They don't. In fact, they have the same amount of testosterone as men with full heads of hair.
Baldness is genetically determined. Now it is true that some testosterone in the body is converted to a chemical DHT, or dihydrotestosterone, and that chemical can bind to follicles and weaken them, eventually causing the hairs to fall out.
However, that's only in men genetically pre-disposed to baldness. But even with men who are so predisposed, most of that seems to stabilize in their 30's, so it's highly doubtful that testosterone will make things any worse.
Besides, the baldness drug Propecia specifically reduces the formation of DHT, so those who are overly concerned about TRT and hair loss can use it to ameliorate their fears (and presumably, their feared hair loss).
A couple of years ago, the FDA became worried about testosterone. Most of their worries stemmed from a single study that appeared in the journal PLOS One (3).
The authors of the study examined a large healthcare database for guys who'd been on testosterone replacement therapy for 90 days. Younger men with a history of heart disease who started TRT had a two to three-fold increase in the risk of myocardial infarction. Guys over 65 who started TRT had a two-fold increase in the risk of myocardial infarction, regardless of their cardiovascular history.
The study had several problems, though:
- The study didn't consider levels of testosterone before treatment or after treatment. Therefore, we have no idea if the men had low testosterone in the first place, or if in fact they were being grossly overdosed.
- The study didn't monitor estrogen levels or red blood cell levels. If high estrogen levels aren't addressed by medication and high red blood cell counts aren't adjusted by changes in dosing, heart problems are possible.
- The study's entire control group was on a drug that prevents heart attacks, making the comparison between them and the testosterone group ludicrous.
So let's throw that study aside, preferably over a bridge and into a raging river. Consider that about a month before that study was published, The Journal of the American Heart Association published a meta-study that compiled the results of over 100 studies on testosterone and heart health. They found, unequivocally, that higher levels of testosterone were essential to heart health.
In fact, the journal reported that low T was associated with a higher rate of mortality in general, along with higher rates of cardiovascular mortality, obesity, and diabetes.
The list of possible conditions associated with low testosterone was downright scary:
- Higher risk of cardiovascular disease
- Narrowing of carotid arteries
- Abnormal EKG
- More frequent congestive heart failure
- Increased incidence of angina
- Increased body mass index
- Type II diabetes
- Metabolic syndrome
- Insulin resistance
- Increased belly fat
- Higher death rate from all causes, including cardiac mortality
So what it comes down to is that you have one ill-conceived study portraying testosterone in a bad light, compared to at least 100 others proving that low levels of testosterone are bad, very bad, for your health.
But let's look at one more study, just to put your mind at ease. Three years ago, researchers at the Intermountain Medical Center Heart Institute recruited 755 heart patients between the ages of 58 and 78 who also tested low in testosterone.
The men were divided into three groups, two of which received testosterone replacement therapy in the form of gel or an injectable, and one group that served as the placebo group.
After one year:
- 64 patients who weren't on testosterone replacement therapy suffered a major cardiovascular event (stroke, heart attack, or death).
- Only 12 patients on medium doses of testosterone experienced a major cardiovascular event.
- And only 9 patients on high doses of testosterone experienced a major cardiovascular event.
In other words, non-testosterone patients were 80% more likely to suffer an adverse event.
The same trends continued 3 years later. One hundred twenty-five of the untreated men experienced stroke, heart attack, or death, as compared to 38 of the medium-dose testosterone replacement patients and only 22 of the high-dose testosterone replacement patients.
Clearly, normal or even slightly higher than normal testosterone levels are good for the heart and cardiovascular health in general.
Paradoxically, it's often men with low testosterone levels that are moody, depressed, and even angry, while men with normal or high testosterone levels are generally sociable and gregarious.
Dr. Christina Wang of UCLA found that men with low T were likely to be snarkier and more aggressive than men with high T, but once the snarky ones received T replacement, their attitude and anger disappeared (3).
There are exceptions to this, though. Improper usage (very high doses) of testosterone or steroids could elicit aggressive tendencies ("roid rage") in men that might be predisposed to such behavior. Likewise, socioeconomic status can play a role, too.
Experience (and a couple of studies) shows us that a good deal of societal misbehavior comes from men with high testosterone levels but low socioeconomic status. Men who are high in testosterone but also high in socioeconomic status can usually restrain themselves because they know they have more to lose.
Most doctors don't measure testosterone levels. Historically, it just hasn't been part of the standard health panel of drug tests, but it damn well should be.
If they do measure testosterone levels, however, they'll almost always measure something called "total testosterone," which is, as the name implies, a measurement of the total amount of testosterone flowing through your veins.
The numbers might range anywhere from 300 to 1100 (nanograms per deciliter of blood). The trouble is, it tells you almost nothing about your hormonal status. For one thing, blood values of testosterone vary by the minute.
The only way to get a reasonably accurate reading would be to collect urine over a 24-hour period and have the lab use it to measure testosterone and its metabolites. Alternately, you could donate at least three blood samples from different times of the day. The lab would then pool the samples together and test that sample.
But those ways are more expensive, more time consuming, and more inconvenient. And even if you did pool multiple blood samples, it still wouldn't tell you much. For one thing, even though the results might indicate that you have a "normal" level of testosterone, it might not be normal for you.
Or maybe you had a reading of 1,000 in your twenties, but now you're getting by on a comparatively low level of 400. While 400 is considered normal, it might not be an optimum level for you. The only way you'd know what was normal for you is if you'd established a testosterone baseline reading before you turned 30, but hardly anybody does that.
Then there's the issue of steroid hormone binding globulin, or SHBG. It's what's called a glycoprotein and it literally binds up the sex hormones, including, on average, about 60% of your testosterone, and that percentage keeps climbing as you grow older.
The more SHBG you have, the more of your testosterone is bound up, leaving less of it free to do all the good stuff. So while your testosterone level may be as high as 600, a good portion of it could be locked up.
That's why, at the very least, when trying to determine your testosterone levels, doctors should ask the lab for your total testosterone levels, your "free" testosterone levels, and your "bioavailable" testosterone levels so you can get a little bit better of an idea of what your testosterone situation is.
Determining normal T levels is tricky, so regardless of what your lab values are, and given the problematical nature of the lab tests, you have to instead rely on symptoms and the simple desire to be more than you are, hormonally speaking.
While many men first seek out TRT because they're having trouble with erections or experiencing a diminished sex drive, there are plenty of other symptoms of low testosterone.
There are the usual ones like low energy, an inexplicable increase in body fat or belly fat, and depression, but also something much more subtle and rarely addressed: A failure to take the initiative in situations where it's called for.
This last one is tricky because there's a term for people who don't take the initiative in situations where it's called for and that term is "still alive." Not much bad stuff happens to meek people. They lead safe little lives. Of course, nothing much good happens to meek people, either.
They might not get the jobs they wanted, the women they loved (probably from afar), or even something as mundane as a parking spot close to the deli because they lost out to people who were just a little bit more assertive; a little bit more willing to take the initiative.
If you find yourself constantly losing out and berating yourself because you didn't take action when you wanted to, it might just be a case of low-testosterone induced lack of confidence.
Generally, the only hormone lay people associate with women is estrogen, but the testosterone level of a healthy woman is about ten times greater than her estrogen levels. Testosterone actually plays a huge role in women's health, psyche, and libido, just as it does in men.
And, just as in men, low testosterone levels in females can lead to problems, including a decrease in bone and muscle mass, a gain in body fat, and decreases in sexual desire and energy.
However, it's imperative for women to work with a physician skilled in testosterone replacement. Over time, higher-than-desired doses could lead to unwanted side effects such as the growth of body hair or growth of the clitoris.
The latter could be a positive benefit as it could very well increase sexual pleasure, but large doses, over extended periods, could lead to extreme growth of the clitoris with unpleasant social repercussions. More details here: The Female Low Testosterone Epidemic.
There's an element of truth to this lie. If you introduce additional testosterone into your body, your own supply is suppressed and the clearance rate increases. As a result, the testicles may take a vacation and actually shrink.
Simultaneously, the production of sperm cells will slow or stop. This is why the World Health Organization was thinking about recommending the use of steroids as a male contraceptive a few years back.
What the fear mongers don't tell you, however, is that these side effects are temporary and that the testicles almost always rebound within a few weeks of cessation.
However, in the case of stubborn testicles that don't want to come back from whatever sunny shores they're vacationing in, they can be coaxed into duty by the use of drugs like Clomid and HCG.
- Morgentaler A. Testosterone and prostate cancer: an historical perspective on a modern myth. Eur Urol. 2006 Nov;50(5):935-9. PubMed.
- Feneley MR et al. Is Testosterone Treatment Good for the Prostate? Study of Safety during Long-Term Treatment. J Sex Med. 2012 Aug;9(8):2138-49. PubMed.
- Huo S et al. Treatment of Men for "Low Testosterone": A Systematic Review. PLoS One. 2016 Sep 21;11(9):e0162480. PubMed.
- Intermountain Medical Center. Study finds testosterone supplementation reduces heart attack risk in men with heart disease. ScienceDaily. 3 April 2016.
- Wang C et al. Testosterone Therapy Improves Mood in Hypogonadal Men. J Clin Endocrinol Metab. 1996 Oct;81(10):3578-83. PubMed.