So, what are the symptoms that would indicate that a man may have low testosterone levels? Well, it’s generally a combination of things – I will give a quick rundown of the common symptoms of low T here.

Low Sex Drive

The first symptom that most people think of when you say ‘low testosterone‘ is a reduced libido. From my experience, when you have low T you just don’t really think about sex much at all. It generally bothers the man suffering from low T much less than it bothers his partner. It’s usually the woman who asks ‘is it low T‘ before their partner!

For our female readers (yeah, we get a lot of them), I would give this advice:

If you are in a relationship with a man aged over 35 and he doesn’t want sex anymore, get his T levels checked. When a guy with low T gets his testosterone level in check he can literally go from ‘birthday and Valentines day’ to almost every day within a month. It’s really that striking.

The symptoms of low testosterone levels in men

Erectile Dysfunction

Got ED? Before you reach for the Viagra, first ask yourself, is it low T?

The penis actually contains testosterone receptors – they are located in the ‘corpora cavernosa’, which are the chambers which control an erection. One study has shown that testosterone therapy resolved ED issues in one third of men who tried it. Why was this study not bigger news? Probably because the drug companies can make more money selling you Viagra and Cialis.

Lack of Energy/Depression/Brain Fog

I have already written a fair bit about depression and brain fog.

These are the symptoms of low T that nobody seems to talk about, even though plenty of studies have definitively proven the link. This was the most striking difference for me when I started testosterone therapy – within a few weeks my mood improved dramatically and my brain just worked ‘quicker’. It was literally like a curtain being lifted.

Decreased Muscle/Increased Fat

Low testosterone causes obesity, and obesity causes low testosterone. It’s a vicious cycle – if you’re gaining a lot of weight around the middle, and you share some of the other symptoms of low testosterone discussed here, when you try to fasten your pants in the morning ask yourself is it low T? Numerous studies have proven that men who start testosterone therapy gain muscle and lose fat very quickly.

So, there you have it. If you are a man aged over 35 (maybe even 30) and you have any of the symptoms of low T, you should get your testosterone level checked. I know, you’re a man and you hate going to the doctor, but this is totally worth it. I even tell you exactly which tests to ask for in my ‘newbie guide‘.

You have everything that you need to take action! What are you waiting for? It’s time to find out – is it low T?

I’m thinking of a number.

This number could have a huge impact on every aspect of your life, and you have probably never given it a second thought. This number is something that you can successfully manage to improve your quality of life, but I’m guessing that you have absolutely no idea what it is. It’s your testosterone level. Is low T center of your problems?

Low testosterone is estimated to affect as many as 25% of all men in the United States. The medical community are in agreement that it is a hugely underdiagnosed and undertreated problem.

Millions of men are living with low T symptoms, and while it can be be a huge quality of life issue, the sad part is that they often have no idea how bad things are until they fix it. It’s easy to just rationalize the symptoms of low T as a side effect of getting older, but it doesn’t necessarily have to be this way.

If your testosterone level is low you are at greater risk of:

• Depression
• A ‘sub-optimal’ relationship with your partner
• Low energy levels, and generally feeling like crap
• Generally getting fat and lazy
• Serious stuff like diabetes and even a possible link to cardiovascular disease

In subsequent posts I’ll outline some of the research that has been performed in each of these areas, discuss the various treatment options available for low testosterone levels (including their drawbacks), and talk about what you can do to figure out – is low T center of your problems?

OK, let’s see if you can concentrate for long enough to finish this article…..

Low T has quite a few weird symptoms that most guys don’t really notice that they have until they fix them. A classic example of this is what I will call ‘brain fog‘. The scientific studies that have looked at this use the term ‘mental function’.

If you have suffered from low T you probably know exactly what I’m talking about here. You get halfway through a conversation and forget what you were talking about. You find yourself in the kitchen with absolutely no idea why you are there. For me it was like a detached, spaced out feeling – like I was observing life as opposed to participating in it.

The hard part here is that once you have felt like this for a while, it just feels ‘normal’ to you. You stop characterizing it as a problem – it’s just a characteristic of you.

Trouble Concentrating?

A few years ago, I found out that my T level was  355 ng/dL at 35 years old. It’s important to note that this is not a ‘rock bottom’ reading – check out the guide to ‘normal levels of testosterone’ on WebMD here. I wasn’t at the level of what would always be considered a ‘clinical’ problem, even though I had the T level of a 75 year old man!

Anyway, long story short (and I will get into the long story in later posts), by the time I got up to 500 ng/dL I felt like a different person. At 650 I felt like superman, but again I’ll tell that story later!

The first improvement that I noticed was my ‘mental function’. I don’t have a good way to describe it other than my brain just felt ‘quicker’. I could concentrate on one thing for long periods of time, I seemed to always have a witty comeback to any comment, I just generally felt more ‘connected’ to what was going on around me.

It’s hard to explain, but I really felt like I had just been observing the past few years as opposed to living them, and I didn’t even realize I had a problem until I fixed it. This prompted me to do some research – it turns out that my experience is fairly common (try googling testosterone and brain fog or concentration – it seems to be really common). There is also a growing body of medical research on this topic – the best summary I have found of the existing research can be found in the January 2008 issue of Harvard Men’s Health Watch (which you can get here for 5 bucks).

Anyway, the moral of the story is this – if you’re a guy aged 35+ and you feel ‘spaced out’ all of the time, get your T level checked. If it turns out that it’s related to low T then you have options open to you – it’s a condition that can be managed to improve your quality of life.

I have had a couple of comments from people that this site is too depressing and that I should lighten the subject matter. Clearly I have chosen to ignore that advice as I kick off the first of many articles that I will write about low T and the link to depression.

I used to suffer from low T, but I didn’t know that at the time. I also used to have a real problem with seasonal allergies, which I knew about all too well. Every year, as soon as spring hit I would be sneezing and sniffing for a couple of months, and none of the OTC meds seemed to help in any way.

Take these pills - they will fix you up good!

Anyway – so here’s what happened.

I’m a man, so I hate going to the doctor and will do anything to avoid it, but finally my allergies were so bad that I figured I would try to get him to prescribe me something stronger to combat them. While he was writing the prescription, I also happened to mention to him that I had been feeling a bit down for a couple months, and that I figured my allergies were contributing to it. Not ‘head in the oven’ suicidal, just not that great, you know?

The look on his face changed – feeling down? Are you having trouble sleeping (yes)? Less interested in your job (yes, I spend 8 hours a day doing meaningless tasks for assholes, it sucks)? Trouble concentrating (sorry, what was the question again)?

Next he pulls out a short questionnaire and asks me to fill it in. I noticed that the questionnaire had the name of a drug company written on it, which should have been a red flag, but I filled it in as best I could.

The questionnaire was one of the standard depression tests that the drug companies produce to figure out if you need to take their drugs – what is known as the ‘PHQ-9 Assessment’. You can try it for yourself at http://www.webmd.com/hw-popup/risk-of-depression.

Try playing around with your answers for fun, just to see what it tells you. I’m betting that for most 40 year old guys with a desk job that they don’t like, mild insomnia and a crappy diet, this thing would at least put you at borderline depressed. Just for fun, it’s worth googling the symptoms of low testosterone and then looking at the test again. Do you see the connection here?

Anyway, long story short, I walked out of the office with both my seasonal allergy prescription and a prescription for Paxil. Worst f@!&ing doctor ever, right? No attempt was made to look for underlying physiological issues like a low T level, or even thyroid function. The subject was never even approached.

Anyway, even longer story short, after six months or weird buzzing noises in my head, even worse insomnia, a complete loss of interest in everything I cared about and almost no sex, I came off the anti-depressant. I was really lucky too – coming off for me was a breeze. Check out http://www.paxilprogress.org/forums/ to see 260,000 posts about how hard it is to come off this stuff, and just how many problems people have had with it (do not sue me please GlaxoSmithKline – just presenting my opinion here).

Over the next few depression related articles, I will present the scientific evidence of the link between depression and testosterone levels, and I will talk about my experience when I discovered the link between feeling ‘generally sub-optimal’ and my T level.

I’ll also talk about why it is so rare for men to have their T levels checked. First of course, they are men – so they will avoid going to the doctor. Second, the drug companies can’t make as much money from treating low T as they can from ‘treating’ depression. Synthetic testosterone has been around since 1935 – it’s hard to make money from since the only patents that a company can get now are on the delivery method (for example, putting it in gel form). On the other hand, a single anti-depressant drug can make over $3.5 billion a year.

The drug companies control medicine in the US, and they are not here to help you, they are here to create value for their shareholders. That’s just capitalism – if you don’t like it, move to North Korea.

No, really – I’m serious.

Pro tip - the internet has pictures of naked ladies on it. Really!

Low testosterone makes you depressed – the evidence is conclusive on this point, it’s no longer even up for debate. Check out some of the posts on low testosterone levels and depression here.

The good news is that scientists have discovered that the simple of act of getting a boner can raise your T levels. From the article at Suite101:

German scientists have found that having an erection can boost circulating testosterone levels naturally. Aim to have at least one per day!

Those Germans are smart people – you should listen to them. When I’m over 600 ng/dL I’m so happy that I pole vault out of bed every morning, ready to face the day!

1000 ng/dL is a different story – too much of a good thing. That’s when I want to beat folks up in the supermarket, and I find myself shaking my fist at people and shouting in meetings. But that’s a story for another post…..

]]> http://www.understandinglowt.com/feeling-down-try-getting-a-boner/feed/ 2 http://www.understandinglowt.com/hacking-your-hormone-levels-on-oprah/ http://www.understandinglowt.com/hacking-your-hormone-levels-on-oprah/#comments Tue, 02 Jun 2009 02:51:49 +0000 admin http://www.understandinglowt.com/?p=93

Women are really interested in hacking their hormone levels. Even Oprah is doing it – from the article in Newsweek:

Hacking your hormones for fun and profit!

“After one day on bioidentical estrogen, I felt the veil lift,” she wrote in O, The Oprah Magazine. “After three days, the sky was bluer, my brain was no longer fuzzy, my memory was sharper. I was literally singing and had a skip in my step.” On the show, Oprah had her own word of warning for the medical establishment: “We have the right to demand a better quality of life for ourselves,” she said. “And that’s what doctors have got to learn to start respecting.”

Obviously, Oprah is a woman and was talking about getting her estrogen level in check, but this pretty well describes the feeling that most men get when they get their testosterone level to a good place. For me, it felt like my entire perception of reality was adjusted – it was that dramatic. I’m not just talking about old guys here either – I was 34 at the time. I also didn’t have a ‘rock bottom’ T level – just going from ‘low normal’ to ‘normal’ levels was enough for me.

It seems to me like hacking your hormones is something that most women would consider doing – its use is already widespread. For men, it’s still very underground – it’s only really the bodybuilding community, the anti-aging crowd, baseball players <ahem>, and hollywood celebrities that are doing this. Why is this? Why is your average 40 year old guy with a desk job not doing this if it improves his quality of life?

I predict that within the next few years we will see a major paradigm shift here. Generation X man is growing old, and it’s getting old.

This is a hedonistic generation that has grown up around recreational drug use, the meteoric rise of nutritional supplementation and the relentless bombardment of ‘big pharma’ marketing. They want to feel good, and they are prepared to hack their hormones to get it. They will take the pills, rub on the gel, take a shot in the ass once a week – whatever it takes to look good into their 60s, ward off depression, and still get laid from time to time.

That’s the salient point with Oprah’s message – she is not hacking her hormones to treat a medical condition, she is doing it to feel good!

Personally, I hope that Oprah’s message gets through to all the women out there. Hopefully it will keep them attractive and sexually active into their 60s – I intend to have the testosterone level of a 20 year old when I am that age, and I’ll still need to get laid.

OK, flame away – I know that there are two sides to this argument, but this one was just so funny that I had to post it.

His name was Robert Paulson

There is a growing feeling that low T is a 21st century epidemic in the developed world. One lab that does hormone level testing (ZRT Lab) released an article (PDF warning) stating that testosterone levels are now 15-20% lower than they were 15 years ago. One example study that they give (from Scandinavian researchers) showed that a man born in 1970 had about 20% less testosterone than a man of his father’s generation.

So, what’s causing this? Well, there are lots of theories (some genuinely interesting, some just plain dumb) – but fasten on your tin foil hat as I present this week’s ‘crazy low t conspiracy theory of the week‘.

You may have heard the theory that too much soy in your diet contributes to low testosterone levels. The research on this is mixed (google it), but one recent article in the journal ‘Endocrine Practice’ was a classic.

In a nutshell, some guy drank 3 quarts of soy milk a day and grew breasts.

I have to stress that this is not from the National Enquirer – this is from a respected Endocrinology journal – the full article is available on Medscape (registration required). A summary of the article is below.

Hold on to your hats – here comes the science!

From the article:

Abstract

Objective: To document a case of gynecomastia related to ingestion of soy products and review the literature.

Methods: We present the clinical course of a man with gynecomastia in relation to ingestion of 2 different soy products and review related literature.

Results: A 60-year-old man was referred to the endocrinology clinic for evaluation of bilateral gynecomastia of 6 months’ duration. He reported erectile dysfunction and decreased libido. On further review of systems, he reported no changes in testicular size, no history of testicular trauma, no sexually transmitted diseases, no headaches, no visual changes, and no change in muscular mass or strength. Initial laboratory assessment showed estrone and estradiol concentrations to be 4-fold increased above the upper limit of the reference range. Subsequent findings from testicular ultrasonography; computed tomography of the chest, abdomen, and pelvis; and positron emission tomography were normal. Because of the normal findings from the imaging evaluation, the patient was interviewed again, and he described a daily intake of 3 quarts of soy milk. After he discontinued drinking soy milk, his breast tenderness resolved and his estradiol concentration slowly returned to normal.

Conclusions: This is a very unusual case of gynecomastia related to ingestion of soy products. Health care providers should thoroughly review patients’ dietary habits to possibly reveal the etiology of medical conditions.

Drug side effects – they can sound funny, unless they are happening to you.

At the end of every drug commercial they list the side effects. After a while you start to tune them out, like your average smoker tunes out the giant warning on a pack of Marlboro. It just becomes ‘noise’. May cause drowsiness, diarrhea, giant weeping open sores, you might grow cloven hooves etc. Or my personal favorite, ‘oily anal discharge’.

As much as we tune these warnings out, it’s important to note that the side effects of some low testosterone treatments are pretty crazy – maybe not to you, but to your significant other or your kids. No ‘oily anal discharge’ here – something much weirder.

A few weeks ago the FDA asked the makers of popular testosterone ‘gel’ treatments to put a new warning on the product packaging. Apparently some guys had managed to rub up against their kids while wearing the gel, with bizarre consequences. From the FDA site:

Oily Anal Discharge? WTF?

Despite the currently labeled precautions, as of Dec. 1, 2008, the FDA has received reports of eight cases of secondary exposure to testosterone in children ranging in age from nine months to five years. Since that time, additional reports of secondary exposure have been received by the agency and are presently under review.

Of the fully reviewed cases, adverse events reported in these children included inappropriate enlargement of the genitalia (penis or clitoris), premature development of pubic hair, advanced bone age, increased libido, and aggressive behavior.

In most cases, the signs and symptoms regressed when the child no longer was exposed to the product. However, in a few cases, enlarged genitalia did not fully return to age-appropriate size and bone age remained modestly greater than the child’s chronological age.

In some cases, children had to undergo invasive diagnostic procedures and, in at least one case, a child was hospitalized and underwent surgery due to a delay in recognizing the underlying cause of the signs and symptoms.

Trust me, you don’t want little Johnny to be the only kid in first grade gym class with a beard. Be careful out there folks! Follow the instructions with these medications, and keep yourself and your family safe.

For some guys, a pharmaceutical approach is all that will work. If you have extremely low T and you feel really bad, it’s your judgment call as to whether the benefits of this therapy outweigh the potential risks. Just don’t kid yourself that there are no side effects – go into it with your eyes open.

If you find that your testosterone level is just at the upper end of the ‘low’ scale, you may find relief from natural remedies, and I would always recommend trying this in the first instance. Get your testosterone level tested, do the right things for a month, then test again and see if you really need the pharmaceutical approach. There are supplements that you can take, bad habits that you can cut and good habits that you can introduce that really have a marked effect on your testosterone level.

Just don’t believe 90% of what you read online – there is a lot of money to be made in ‘treating’ this stuff naturally, and most of what you will read is complete crap with no scientific basis. There are a couple of supplements with real studies behind them (like ZMA – you can get it here – link goes to cheapvitamins.com who are usually the cheapest – and find links to the study here), but most of it is crap. I don’t recommend any particular brand either – again, I’m not selling miracles. My advice – search for it, and if you want to try it, buy the one with the least expensive looking packaging! You don’t want to pay for marketing, right?

A low testosterone level makes you fat, and being fat lowers your testosterone level. It’s a vicious cycle.

Lose the belly, control your hormones

As you know, testosterone and estrogen are like your ‘yin and yang’ – people of both sexes have both hormones, and the balance of these two hormones is what makes us have male or female characteristics. Something interesting that you may not know – a high level of body fat in men actually tips the balance of power towards estrogen. Here comes the science:

Body fat contains an enzyme called ‘aromatase’ that takes your testosterone and converts it into ‘estradiol’, which is a primary type of estrogen. This explains in part why overweight men often grow ‘man breasts’ (clinically known as gynecomastia), because the conversion of testosterone to estradiol stimulates breast tissue growth.

So, a great first step in combating low T is to start shedding body fat. As your body fat drops, you have less aromatase, so you get less estradiol, so your hormone levels get some help to get back to where they should be. You can break the cycle.

Losing weight for men is easy – in my experience it’s much easier for men than women. Simply eat less and move around more – salad instead of pizza, take the stairs instead of the elevator, etc. I have personally seen guys work miracles in a couple of months as soon as they realize that losing weight is just math – take in a little less fuel, burn a little more.

Getting your body fat under control is probably the single most important health step that you can take. Start today – it’s not nearly as big a pain in the ass as you think it might be!

Low T treatment has been around for more than sixty years. It is well understood, generally well tolerated and available in a surprisingly wide range of treatment options. Which one is for you?

Testosterone Creams and Gels

This is the most common form of low T treatment in the US, with just two FDA approved formulations (Androgel and Testim) controlling more than 60% of the market. Under guidance from a medical practitioner, the gel is applied once a day to the skin, usually on the upper arms and shoulders.

If your doctor diagnoses you with low t, you will most likely be started on the gel as an introduction to low T treatment. It’s reasonably convenient, reasonably well tolerated, and it can get your low T levels back up very quickly. It is also very heavily marketed – both to consumers and to doctors.

Personally, I am not  big fan of this type of low T therapy. I hate having to be careful not to get it on my wife and kids (nobody wants a bearded five year old), I hate the smell, I hate having to let it dry and being unable to shower for a few hours after applying it. It’s a nice introduction to low T treatment, but many guys switch to injections for the long term. The cost can also be prohibitive without insurance – as much as $500 per month.

Interestingly, you can also get non-FDA approved compounded testosterone creams from many compounding pharmacies that do a similar job for much less money. As a reminder of just how crazy the world of big pharma is, it’s also worth noting that the makers of Androgel are actually paying other companies to not make a generic version of testosterone gel. The FTC recently filed a complaint about this – read about it here.

Testosterone Pills

Amazingly, there is no good ’1 pill a day’ low T treatment. I predict that someone will produce one within the next couple of years, and that it will be a billion dollar drug. The makers of Androgel actually appear to be working on this right now.

Most testosterone pills that have been created over the years are extremely liver toxic. The exception to this rule is Andriol, but it is not available in the US. It’s also not generally as effective as most of the other low T treatments listed here.

Testosterone Pellets

Just like they do with cows! You get a little pellet inserted under your skin, and it releases a steady stream of testosterone over 3 to 6 months.

I have personally never tried this low T treatment, and I’m not sure that I want to quite honestly. Let me know if you have tried it – it sounds intriguing once you get over the fact that you will have a foreign object buried under your skin for an extended period. Blergh.

Injections

Low T Treatment

The grandaddy of low T treatment. In 1889 some bright guy called Charles-Edouard Brown-Sequard injected himself with an extract that he had made from the testicles of dogs and guinea pigs. He reported back to the medical community that ‘it was awesome’ (or words to that effect) and thus low T treatment was born. Hooray!

These days, you don’t have to grind up any testicles to get your testosterone fix. Your doctor can prescribe you testosterone with an ‘ester’ attached to it that will slow absorption, allowing for less frequent injections. In the US, the most common esters used are called enanthate and cypionate.

The ‘less frequent injections’ is the point to be aware of here. Most doctors will prescribe one injection every two weeks, which has never been ideal for me as a treatment for low T. I find that after the 10th or 11th day I can really feel that my T levels are low again, and I hate this ‘roller coaster’ effect. Everyone is different, but for me every ten days has worked out to be ideal.

To make this routine less annoying (and less expensive) your doctor can allow you to pick up your own multi-use vial of testosterone from the pharmacy, as well as syringes and needles, and you can administer your own shots at home. As daunting as this sounds, it’s actually very easy and painless – I am almost ashamed to admit that I actually enjoy doing it now!

I am not a doctor, and I cannot give you medical advice, but my personal experience is that the gel can be a good place to start, but that you will probably want to end up on the injections for the longer term. Within the next couple of years a new injectible testosterone ester called undecanoate will be approved by the FDA, and this will provide much less frequent shots – perhaps even once every two months.

So, there you have it – a range of low T treatment options. As for side effects, well, nobody can pretend that there are none, but my personal opinion is that if you put me in a room with a bottle of tylenol, a bottle of anti-depressants, and a bottle of testosterone and told me I had to take one, I would take the testosterone every time. The media have vilified testosterone as an ‘evil’ substance, but the reality is that it’s just a hormone – nobody balks at taking thyroid medications, and it’s really no different.

In all my years of testosterone therapy, I haven’t killed anyone, I haven’t beaten anyone up, and I haven’t grown horns or hooves (yet). If you think you have low T, you owe it to yourself to get your testosterone level checked and talk with your doctor about the treatment options. You’ll thank me for it later.

You can find more information about how test your testosterone levels in another post.