A funny thing has happened in the United States over the past few decades. Men’s average testosterone levels have been dropping by at least 1 percent a year, according to a 2006 study in the Journal of Clinical Endocrinology and Metabolism. Testosterone appears to decline naturally with aging, but internal belly fat depresses the hormone further. Drugs like cortisone and opiates also lower it, and chemicals like bisphenol A (BPA, found in plastic containers) and diseases like type 2 diabetes may play a role too.
Many men feel the loss. Clinical testosterone deficiency, which is variously defined as lower than 220 to 300 nanograms of testosterone per deciliter of blood serum, can cause men to lose sex drive and fertility. Their bone density often declines, and they may feel tired and have difficulty concentrating.
But “low T,” as the condition has been labeled, is not nearly as accepted an illness as ads for prescription testosterone would have you believe. Low T is most often a symptom of another condition—be it aging, obesity, or drug interactions, for example—not the problem itself. Pharmaceutical companies, however, have seized on the decline in testosterone levels as pathological, convincing men that common effects of aging, like slowing down a bit and feeling less sexual, actually constitute a new disease—and that they need a prescription to cure it. This is a seductive message to men who just want to feel better than they do and want to give it a shot, literally.
Rx for Concern
Prescription testosterone doesn’t merely give your T level a boost: It may also increase your risk of heart attack, add too many red blood cells to your bloodstream, and shrink your testes. A recent large study published in the journal PLoS ONE found that within three months, taking the hormone doubled rates of heart attacks in men 65 and older, as well as in younger men who had heart disease. The Food and Drug Administration (FDA) has begun an investigation.
The issue bears a stark resemblance to the hormone trial in the 1990s and early 2000s in which middle-age women took synthetic prescription estrogen and progesterone to treat menopause, among other reasons. But by 2002, we knew that those hormones raised the risk of stroke, heart disease, and invasive breast cancer in healthy women.
The number of testosterone prescriptions given to American men has tripled since 2001. Used clinically since 1937 and approved by the FDA since 1953, testosterone is now administered in at least five forms, including patches, gels, and injections. Three million prescriptions were written in 2012 for market leader AndroGel alone. Sales of all testosterone-boosting drugs are estimated to have been $2 billion in 2012.
Too many doctors are writing prescriptions without even measuring patients’ hormone levels, much less retesting and adjusting the dose after prescription. Up to a quarter of these prescriptions are dispensed without a blood test. From a psychological perspective, this isn’t helping men. From a medical perspective, it must be addressed. In addition to cardiac risks, prescription T can shut off men’s own natural, albeit diminished, testosterone production.
Natural Ways to Boost T
Instead of heading to the pharmacy to get their fix, men should address the leading cause of the problem. Losing weight is a tried-and-true way to naturally boost testosterone levels. According to findings presented at the annual meeting of the Endocrine Society in 2012, obese men who lost an average of 17 pounds saw their testosterone levels increase by 15 percent. In general, a man’s waist should be half his height.
Some diet changes may be useful for reasons other than just weight loss. Cut back on booze—alcohol lowers testosterone levels. Eating more whole foods and fewer junk foods improves mood and energy, which may be the only fix many men need. What they don’t need: a prescription for a risky drug to treat a questionable disease.