This week, I’ll have a look at hormonal changes in men and what benefits there could be to addressing those with a medical intervention.
Do men require testosterone therapy as they age? What are the benefits and drawbacks of exogenous testosterone?
Get-Fit Guy is hosted by Kevin Don. A transcript is available at Simplecast.
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Welcome back to Get-Fit Guy, I’m Kevin Don. Recently, we discussed the anti-aging properties of strength training for two of the major hallmarks of aging: sarcopenia, or loss of muscle mass, and osteopenia, or loss of bone mineral density. But what about some of the other side effects of aging? Hormonal changes, skin changes, body composition changes, vision and cognitive changes? What protocols are there to address those? This week, I’ll have a look at hormonal changes in men and what benefits there could be to addressing those with a medical intervention.
As we age, researchers estimate that, in general, men lose about 1% of testosterone production a year after age 30. Around 3% of the adult male population in the U.S. are receiving TRT, or Testosterone Replacement Therapy, and that’s just the patients who are getting it through official channels, with many more self-administering without proper medical supervision. So, what is testosterone and why is it important in men?
Testosterone is a hormone. It’s the primary sex and anabolic (muscle-building) hormone in males. It is responsible for the development of male sexual characteristics, the development of muscle and bone mass, as well as things like body hair distribution, the deepening of the voice, and other secondary sexual characteristics.
Low levels of testosterone have been positively correlated with depression and cognitive decline such as Alzheimer's. It has also been correlated with low levels of muscle mass and bone density, as well as increased metabolic syndromes, cardiovascular disease, and mortality. Inflammatory markers were also high in the absence of sufficient testosterone levels.
There, are, of course, two sides to every story, and excessive testosterone levels have been correlated with increased aggression, hypersexuality, criminality, and physical effects such as male pattern baldness.
The idea that testosterone therapy is good for men isn’t something new—in fact, in 1889, Charles Edward Brown-Sequard noted feeling “rejuvenated” after self-administering an elixir made from the testes of guinea pigs. This was even used by Hall of Fame Red Sox player Jim Galvin, in perhaps the first noted use of performance-enhancing drugs in modern sport. Some very wealthy older men even received testicle transplants from goats and monkeys. In 1935, testosterone itself was isolated and identified in a Nobel Prize-winning effort and a whole industry was launched around testosterone as a pharmaceutical intervention. In spite of the anti-aging clinics recommending monthly injections for men over 30, the FDA actually only approved testosterone injections for one condition: hypogonadism, where there are genetic conditions affecting the testes or perhaps a damaged or missing testicle. So why are there so many prescriptions for TRT and is there any off-label benefit in terms of anti-aging?
Well, I think we have to first of all recognize that needing something and benefitting from something are not one and the same. With no generally accepted point as a measure for low “t” levels, men of varying blood serum levels of testosterone could indeed have benefits from increasing levels. In fact, it may even be that men would have greater energy and libido from purely placebo. Luckily, this exact thing was tested. Researchers split men waiting for TRT into two groups: one would receive testosterone gel and the other a placebo. Both groups noted improved energy and libido, with no significant difference between the groups.
So, if testosterone replacement gels and injections aren’t having a significant impact on low testosterone symptoms above that of placebo, what could be causing the symptoms? Some medical experts are positing that low testosterone symptoms are being caused by metabolic syndromes and are the side effects of chronic diseases such as obesity and lack of physical activity.
It is also generally agreed upon that TRT introduces a new problem, that of a pharmacological feedback loop. When you introduce exogenous testosterone, your body recognizes there is plenty in the system and shuts down natural production. Of course, this lowers levels further, requiring more exogenous hormone, which then shuts you down even harder, resulting in an ongoing dependency on gels or injections to keep enough testosterone in the system. Great news for pharmaceutical manufacturers, perhaps less good news for your endocrine system.
So what about natural ways to boost or enhance your testosterone without shutting yourself down? I remember someone saying to me that natural testosterone boosters didn't work, because if they did, they would be banned in sports and yet they aren't. But I’m not so sure I buy into this, purely because sporting and athletic enhancement and recovery aren’t the same as someone just feeling a little better. Especially when we consider that TRT doses are around 250mg every 2-3 weeks and strength athletes are hammering 1000mg a week into their systems.
So what natural alternatives are there? Well, in older men, lack of movement and obesity are the major causes of low testosterone levels. In fact, there is an enzyme present in body fat that converts testosterone into oestrogen! We know that obese patients who lowered body fat 10% increased T levels on average by 150ng/dl and those who lost 30% body fat improved T levels by an average of 250ng/dl.
Movement and exercise is also crucial and although the stereotype is of testosterone going hand-in-hand with hitting the weights hard, actually, the most significant T level increases have been seen in aerobic and aerobic interval training. This ties in nicely with my own recommendations that we train ourselves in multiple modalities and move in multiple patterns—ideally, as many combinations that you can. We know lifting weights will help sarcopenia and osteopenia and now we know that declining T levels can be hedged against with aerobic work. So we can see that single modalities of training won't be enough to truly fight the aging process.
Another impactful intervention is getting better sleep. Some experiments on sleep quality and sleep deprivation show a 15% decrease in blood serum T levels from just 7 nights of 5 hours of sleep. Alcohol intake can also adversely affect your hormones, with 3 beers a day for 3 weeks resulting in a 7% decrease in T levels in healthy males.
So, there we have it: a very brief synopsis of testosterone in men and the multi-billion dollar industry that is recommending something not much more effective than a placebo. In the end, it may indeed be in your best interests to seek natural solutions such as losing body fat, being more active, sleeping better, and reducing alcohol intake before turning to pharmaceuticals. Of course, we do have to remember that medical advice is always going to trump personal anecdote, so, if you are thinking of exploring this for yourself, be sure to perform your own due diligence and decide what intervention would be most impactful based on all available data