Search for tag: "testosterone"

Interviewer: Four ways to naturally boost testosterone. Dr. Jim Hotaling is a urologist and a men's health expert. What can I do?

Dr. Hotaling: Simple things you can do are work on losing weight. Even a 10- to 15-pound weight loss can make a big difference. Also, exercise, particularly anaerobic exercise, such as lifting weights. Eating a balanced diet, trying to avoid processed foods, particularly sugar. That can result in changing energy levels and also mess with the natural circadian rhythms that reflect your testosterone production. And the other big thing is sleep. A lot of men have sleep apnea and that can make a big difference in their natural testosterone production. Testosterone levels are a reflection of your overall health. And if you work on making these changes, you should notice a significant difference in two to three months.

updated: April 23, 2021
originally published: May 30, 2019

Interviewer: Andropause is the male version of menopause. We'll find out more about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Jim Hotaling is a urologist and also a men's health expert here at University of Utah Health Care. Andropause, what is it?

Dr. Hotaling: There is a natural decline in testosterone in men after the age of about 30 or 35, testosterone goes down significantly. One of the things that's really tricky is we don't know what the normal testosterone is in a 20 year old, 30 year old, 40 year old, 50 year old. We know maybe in a 50 year old and above what an abnormal testosterone is, which is usually a total testosterone, depending on who you look at, below 350 or below 300.

But again this is a lab test that varies minute to minute and hour to hour and it has to be checked before about 10 in the morning to be accurate. So if a man goes to get their testosterone checked at 4 pm it's almost always going to be low. One thing that's difficult is the testosterone industry has had the most successful marketing campaign in the history of medicine.

So it literally took testosterone from in 2000 being about a $100 million a year industry, I think this year it will clear 2 or 3 billion. It's actually taught at Harvard Business School, the whole concept of low T as exactly how you should do marketing. And a lot of men come in because they're concerned with that. In summary andropause is real, but and this is the big but, you don't treat a number.

You really only treat patients if they have symptoms of low testosterone and have low testosterone. Ideally on one to two measurements in our opinion and everybody's bias, but urologist are great people to do that because they understand a lot of the issues that impact men's health.

Interviewer: So what exactly is it? Is it just a natural lowering of testosterone? Is that all andropause is?

Dr. Hotaling: Essentially, yes. The testosterone will decline in a man every year past the age of 30 or 35.

Interviewer: And is it the male version of menopause?

Dr. Hotaling: It is in the sense that it's a decrease in hormone levels and everything else. But for women it's a different issue because at some point they stop ovulating. Men really never stop producing sperm. There are people who've produced children in their 90s, which that's a topic for a different day, but men never stop producing sperm.

And it's not as severe as it is in woman. It's a very gradual decline and at some point, in some men, it declines to a point where it does cause symptoms and that is where I think there is some resemblance to menopause.

Interviewer: And that's where you as a urologist or a men's health expert would perhaps then consider doing some sort of therapy?

Dr. Hotaling: Yeah, that's correct and typically the therapy is testosterone replacement. There are other medications we can use. The downside to testosterone replacement is it will make men sterile, some men permanently. Most men not. But we can use other medications to actually boost testosterone and keep men's' fertility intact.

There are also some surgical procedures, one in particular we can do to actually help increase a man's testosterone.

Interviewer: So decreasing testosterone or going through andropause is just normal?

Dr. Hotaling: Yeah, it is normal and I think that's the key thing to understand. The testosterone companies would have you believe that you should treat a number. And what's tricky about testosterone is anyone, no matter what their testosterone starts at, will feel better when you put them on testosterone. That doesn't mean that everybody should be on testosterone and I think that's the real challenge.

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Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: If you watch any TV at all you can't escape the ads, ads for you need testosterone therapy. It looks like it's pretty easy to get, but should you get it? That's the question. Right now I've got with Dr. Tom Miller, University of Utah health care.

Dr. Tom, for a guy that's over 30 years old, it's been scientifically proven that testosterone levels start dropping at that point. Should I be ordering some of this testosterone online? I mean after all, I want to look like that guy.

Dr. Tom: I think the question, Scot, is why do you think you need it? What's different?

Scot: So, the ads tell me my energy levels have dropped, which they have, that I start putting on more body weight, that my mood is affected, and my sex drive is decreased. Testosterone is going to cure it. It's kind of cure-all is what they're telling me.

Dr. Tom: That's a great concern. That's a concern of many men, and women, throughout the country, but the real question is are there different causes for those things you mentioned? There are many causes for people being a little overweight, feeling a little fatigued. It isn't just testosterone; it's a whole basket full of causes.

Scot: So, if I came into your office, and I gave you those symptoms, and I said that I want testosterone what would you say to me? Where would you start looking?

Dr. Tom: I would ask a few questions. One I'd ask, "What's your sex drive like? Has it dropped off? Are you interested in sex? Do you have the same drive that you had five years ago?" And if the answer to that is no and that you were concerned about it, I'd then go ahead and measure your testosterone level.

Scot: Okay.

Dr. Tom: But I'd also ask you a number of other questions. If the testosterone levels came back low, then we might do a trial of testosterone replacement, and we would then monitor how you felt. Did it make you feel better over the course of time that we try the medicine? If not, it might be wise to stop it.

Scot: So, let's back up for a second, these ads that I'm seeing on TV, I can just order without a doctor's prescription?

Dr. Tom: No, you have to have a doctor's prescription. There's a doctor on the other end that's asking a set of questions.

Scot: So, when I make that call, there is a doctor?

Dr. Tom: There's somebody that has to write the prescription.

Scot: Got you. How do they know how much I need, because it sounds like you would do tests to find out what the actual level is? It sounds like they're just asking me some questions and if I pass they're going to write me the prescription.

Dr. Tom: That's probably true. I can't attest what other things that they do, I'm not sure that's the best way to get health care. Basically you're telling them that you need testosterone, and they're saying, "Fine. Answer these questions. Here's your prescription." I'm not sure that's the best way to try to define what your problem is. As I mentioned before, the causes of fatigue and weight gain there are multiple issues related to that not just testosterone.

Scot: So, let's pretend that I come into you because I want to be a little smarter about it. You ask me some questions; you decide to run some tests. You find I'm in the normal range, on the low end of the normal range. Would you do anything at that point?

Dr. Tom: I probably would counsel you about your lack of sexual drive. Well, I'd seek more information about that, and it might me that there are other reasons for that aside from the fact that the testosterone is in the borderline range. I suppose if you really wanted to try it we could do a trial.

Scot: Sure.

Dr. Tom: I'm not opposed to that if the patient thinks that's right, but I try to give them a realistic expectation. Also tell them that, "Look, it's not a wise thing to take medicine if we do this for several months and you find there's no difference, and you're honest with yourself about it." Just as with any medicine, in my mind, it doesn't make sense to take it if you really aren't getting a benefit from it.

Scot: So, let's take a look at these ads; they promise me so many things. Let's talk about the benefits of testosterone therapy, just from a strict benefit. Why would I, as a man, even come to you and talk to you about it?

Dr. Tom: Certainly, if you had low levels, it might be affecting your sexual drive, you might have some fatigue, you might have less muscle mass then you were used to. In that instance, if you were replacing testosterone, it might help you quite a bit; you might have a great improvement. The problem though, long term, is we don't really know if the side effect . . . we don't know what the side effects are of testosterone replacement over the long haul greater than five years. We just don't know that yet.

Scot: So, this is kind of the risks part right now, is we don't know what the risk are.

Dr. Tom: We don't really know what long-term risks of testosterone use might be, replacement. There are a number of men that I know who have low testosterone and they don't notice any difference. So, do you replace testosterone by testing for it in men who are low? The answer is I don't think we really know. We don't have enough information. We do know that testosterone helps maintain bone integrity and strength but we're not at the point where we say screening for testosterone is a thing to do.

Scot: So, it falls off as I turn 30, and as I get older. When you're testing, are you testing for the normal range for, say, a 55-year-old man, if I'm 55, or were you...?

Dr. Tom: I want to back you up a little bit; testosterone may decrease variably in men so it's not the same as menopause in women.

Scot: Okay.

Dr. Tom: So, when women enter menopause their levels of estrogen drop precipitously. The same is not uniformly true in men. Some men have lower levels of testosterone over time, but not all. So, it's unclear which men would have low testosterone and others have normal testosterone; we just don't know yet. There's not a recommendation to screen all men for testosterone levels.

Scot: So, you really can't say how much should a 50 year old man have?

Dr. Tom: Well that's correct, I mean because we don't screen.

Scot: Got you.

Dr. Tom: We don't test for testosterone as part of an annual exam in the same way that we test blood pressure or test cholesterol or test blood sugar.

Scot: So, your advice is don't order the stuff on TV because you're playing with something that...?

Dr. Tom: My advice is that if you have questions about the way you feel, whether you have fatigue or decrease in energy level or a decrease in your sexual drive, then you should probably talk to your physician about that and decide if testing your testosterone level is right for you. Nothing wrong with that.

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