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The Rise and Fall of Testosterone

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Testosterone levels naturally decline among men as they age. Here’s what you can do to boost your levels back to normal.

By Guillermo Escalante, MBA, ATC, CSCS; Photography by: Robert Reiff; Model: George Eiferman

You eat six healthy meals a day, weight train five days a week, do a moderate amount of cardio, eat your carefully balanced post-workout meal (with carbs and protein), drink plenty of water, and get at least seven hours of sleep. You’ve been doing this consistently for the past 15 years, but recently you notice some things are starting to change. Your strength starts to decline, you don’t recover as well form your workouts, you feel lethargic and moody, your sex drive is way down and you notice your body composition is heading in the wrong direction. While many will say that this is simply a matter of growing old, research in the field of endocrinology (the study of hormones) tells us there’s an explanation to these changes: low testosterone (Low T).

Testosterone levels not only fluctuate as you age, but also during training and during the time of the day. A study published in the British Journal of Urology concluded, “testosterone levels are stable throughout the morning and early afternoon, declining modestly thereafter.”

Another study published in the Journal of Medicine and Science in Sports and Exercise investigated the effects of weight training on serum testosterone and found that “moderate weight lifting and light weight lifting cause increases in serum testosterone that were greater than those at baseline.”

Andropause (aka male menopause) is the medical term that’s used to describe the signs and symptoms of Low T. According to Sam Anabi, MD, an internal medicine physician in private practice in Pomona (CA), low testosterone levels can start to become apparent in men as young as 30 years of age; however, as men grow older the effects of low testosterone levels become more pronounced. Research has shown that as men age, testosterone levels slowly decline. Unlike women, who go through a distinct change in their hormones and body during menopause, men’s andropause is a rather gradual process that often goes unnoticed.

Some physicians like Dr. Anabi treat men with low testosterone levels and help them get their levels back to a healthy range. Before testosterone-replacement therapy is prescribed, a complete physical is conducted inclusive of a comprehensive medical history review, physical exam and lab tests to ensure the patient is a candidate for the treatment. Once it’s determined that testosterone treatment is appropriate, each patient is monitored every 3-6 months and the prescribing physician will closely watch how the patient responds to the therapy (typically this involves a physical exam and the collection of more blood for appropriate testing). The therapy for low testosterone levels is usually in the form of a prescription testosterone patch, testosterone gel, or testosterone injection.

Since the commonly referenced range for “normal” testosterone levels is quite large [from 250–850 nanograms per decaliter of blood], there are some physicians who will not prescribe testosterone replacement therapy even though your testosterone levels fall on the low end of “normal”. A closer look at the reference range will reveal that the reported “normal” range is composed of a cross section of men between the ages of 20–100. Hence, if you’re a 40-year-old man with a testosterone level of 320 ng/dl, your physician might say that you’re in the “normal” range. However, a closer look at more sophisticated reference tables for “normal” testosterone levels (that break down average testosterone levels for different age groups) reveals that a testosterone level of 320 ng/dl is “normal” for a man between 85–100 years old but is really far below the average level of 668 ng/dl for a man between the ages of 35–44. If you have a forward-thinking physician watching over you, chances are that the testosterone therapy would be prescribed if your levels fall on the low end of “normal.”

Although there are many benefits to testosterone replacement therapy, there are some potential concerns as well. For one, there’s very little research about the long-term effects of testosterone-replacement therapy. Second, men diagnosed with metastatic prostate cancer or breast cancer are not candidates for testosterone-replacement therapy because testosterone can cause these cancers to grow. Finally, conditions such as sleep apnea, high red blood cell count and severe congestive heart failure can potentially be made worse by testosterone therapy.

References:

  1. Crawford, et al. “The association of time of day and serum testosterone concentration in a large screening population.” British Journal of Urology. September 2007.
  2. Schwab, et al. “Acute effects of different intensities of weight training on serum concentration.” Medicine and Science in Sports and Exercise. 1993.

Symptoms of Low Testosterone

1. Mood disturbance including irritability, depression and feeling tired

2. Sleep difficulties

3. Difficulty with concentration/memory loss

4. Loss of muscle size/strength and increased bodyfat

5. Osteoporosis (loss of bone)

6. Decreased sex drive and/or problems with erections

7. Potentially associated with other chronic medical conditions such as diabetes and cardiovascular disease

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