More than fifty years ago the psychologist Abraham Maslow had a revolutionary impact on the field of psychology when he wrote about the Hierarchy of Needs.  His theory is often portrayed as a pyramid with the most basic fundamental needs in the broad base and the concept of self-actualization at the top.  According to Maslow the four most fundamental needs include physiological needs, safety, love & friendship and self esteem.  Critics of his theory have taken issue with Maslow’s rankings; believing he may have overlooked the most essential human need; to “feel alive”.  Perhaps nothing makes you feel more alive than feeling younger, healthier and more vital.  And nothing does all of that better for men than testosterone.

Testosterone is the primary male sex hormone, or androgen.  Circulating levels of testosterone increase at the time of puberty and peak in early adulthood for men.  Testosterone is responsible for men looking like men and feeling like men.  Following that peak is a gradual but steady decline in testosterone levels beginning in the mid-30’s. Declining testosterone levels cause a variety of symptoms including loss of muscle mass and strength, increased belly fat, impaired brain function, disrupted sleep, loss of libido, impaired sexual function and general fatigue.  But, because the loss of testosterone is gradual these symptoms typically occur little by little, and the impact on a man’s life may not be felt until his 40’s, 50’s or later.  This is sometimes referred to as andropause, or the male menopause.  This gradual decline in vitality, function and quality of life is too often attributed to “just getting old” when in reality, many of those symptoms can be reversed with proper treatment.

It is readily apparent to most that testosterone plays a crucial role in male sexual function. Sexual potency peaks along with the raging hormones of a teenager.  Similarly, testosterone is essential for building and maintaining muscle mass, youthful energy and strength.  Considering testosterone therapy to improve the way you look, feel and perform would be good enough for many.  In fact, testosterone therapy has resulted in improved libido and erectile function in middle aged men.[i]  However, recent scientific evidence has demonstrated significant adverse health implications for men with low and declining testosterone levels.  Numerous studies have now established a strong association between low testosterone and depression, metabolic syndrome, type-2 diabetes, osteoporosis and cardiovascular disease.  In one study men with low testosterone had a nearly 50% increase in mortality over a seven year period.[ii]   An unmistakable link has also been established between erectile dysfunction and the development of cardiovascular disease.

Several studies have shown that restoring testosterone to more youthful levels in middle-aged men improved insulin-sensitivity, reduced serum cholesterol, fat mass, waist circumference and inflammatory bio-markers associated with heart disease, diabetes, and metabolic syndrome.  One study concluded that “that testosterone treatment in men has potentially beneficial effects on virtually all of the coronary risk factors, as well as an independent anti-plaque forming action.”  In men with heart failure, testosterone therapy also improved functional capacity, or the ability to perform physical activity without constraint.[iii]

So why aren’t more men getting testosterone therapy?  Many physicians do not recognize the symptoms of low testosterone as a treatable condition. Traditionally, physicians have been reluctant to prescribe testosterone therapy in large part out of a misguided fear of increasing prostate cancer risk.  Recent evidence has called that conventional paradigm into question.  A large meta-analysis out of Harvard University[iv], as well as a collaborative review of 18 prospective studies[v] concluded that no significant association existed between higher testosterone levels and prostate cancer risk.  Conversely, studies have shown an increased risk of prostate cancer and aggressive prostate cancer in men with low testosterone levels.  In a group of middle-aged men treated with testosterone and followed for more than 5 years, there was no increase in the incidence of prostate cancer and PSA levels remained stable.[vi] 

 What is the bottom line?  Any man over 40 or 50 that feels off his game, run down or is experiencing any of the symptoms of low testosterone should have a thorough evaluation looking for cardiovascular disease, pre-diabetes, and osteoporosis among others.  I recommend seeking out a physician experienced in preventive health and hormone therapy for men.  At Alternity Healthcare, we utilize comprehensive evaluations and state-of-the-art diagnostics to form the basis of an individual preventive health program.  Rather than narrowly focusing on just your hormone levels, our comprehensive programs will expose your total health picture and help you to achieve renewed, long-term health and vitality.   

[i] Traish AM, Guay A, Feeley R, et al. The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. J Androl 2009;30(1):10-22.

[ii] Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, Channer KS.  Low serum testosterone and increased mortality in men with coronary heart disease.  Heart. 2010 Nov;96(22):1821-5. Epub 2010 Oct 19.

[iii] Malkin CJ, Channer KS, Jones TH.  Testosterone and heart failure. Curr Opin Endocrinol Diabetes Obes. 2010 Jun;17(3):262-8

[iv] Morgentaler A. Testosterone and prostate cancer: an historical perspective on a modern

myth. Eur Urol. 2006 Nov;50(5):935-9.

[v] Roddam A, et al. Endogenous Sex Hormones and Prostate Cancer: A Collaborative Analysis of 18 Prospective Studies.  JNCI J Natl Cancer Inst (2008) 100 (3): 170-183.

[vi] Coward RM Simham J, Carson CC. Prostate-specific antigen changes and prostate cancer in hypogonadal men treated with testosterone replacement therapy. BJU Int 2009 May; 103(9): 1179-83.