By Richard Brierley MB BS, MRCGP
Testosterone is the most important male hormone. It promotes the growth and development of male sexual organs such as the testes and prostate gland, causes sperm cells to be produced, increases muscle and bone mass, promotes body and facial hair growth, and increases general feelings of well-being, positivity and energy levels.
Back when I first qualified as a doctor in the late 90's, I never came across treatments for low testosterone or considered it as a diagnosis. Nowadays I regularly diagnose it and frequently encounter men on long term treatment with testosterone in the form of gels or injections.
Part of the reason is that the pharmaceutical industry has spotted another potential opportunity to sell drugs and make more money by raising awareness, but it also is part of a more worrying issue...
Testosterone levels in men of all ages have been dropping for decades. The biggest scientific study of this is from 2007 and showed about a 1% per year reduction in average levels since the 1980s. A man in 2004 had about a 17% lower testosterone level than a man of the same age in 1987.
This worrying trend is paralleled by a wealth of evidence to show that sperm counts in the developed world have dropped by around 50% since 1973, with rising levels of infertility.
Overall physical strength in men has also been shown to be dropping steadily.
So do we need to be concerned about these figures? After all, for many of us there is no need to be as physically strong as previous generations. Less of us need to work in manual jobs and modern man in the developed world is less likely to be called upon to physically fight to protect himself, his family, or his country. However, low testosterone is associated with some very real and potentially distressing problems, all of which are on the increase.
Low testosterone levels can lead to:
— erectile dysfunction
— reduced muscle mass and physical strength
— tiredness and difficulty concentrating
— loss of sex drive
— reduced beard and body hair growth
— gynaecomastia (Man boobs)
— osteoporosis (loss of bone density and increased risk of fractures)
The solution might at first seem obvious. A blood test to check levels and if low, replacement therapy with testosterone gel or injections.
There is no doubt that this treatment can improve symptoms considerably, but you need to think carefully about the pros and cons, and I really think that testosterone replacement therapy should be used as an absolute last resort. The big problem is that when you take a hormone treatment, the body detects it, feels that it has enough and then stops making it. Quite quickly the body forgets how to make it, pretty much entirely, so that if for any reason you stop taking the testosterone therapy in the future, your levels will crash and probably never fully recover...
So if you suspect you may have a problem with testosterone deficiency, by all means see a doctor and get a blood test, but pause and think before accepting the only treatment they are likely to offer.
We need to consider carefully the reasons why levels may be dropping and look at natural ways to counter the effects...
A minority of cases have clear medical causes such as undescended testes, mumps, serious injury to the testes, or cancer chemotherapy, to name a few. However, most don't have an obvious cause, but there is still a great deal you can do to boost the levels and improve symptoms.
Testosterone levels can reduce with age and many of us have heard of the so called 'male menopause', but this is far from inevitable. It is believed that the reduction is much more to do with lifestyle factors and behaviour rather than aging, which we can all do something about.
Probably the biggest issue causing a problem with low testosterone is a high body fat content. Body fat cells metabolize testosterone to the female hormone oestrogen. With less testosterone we build less muscle and gain body fat more easily, setting up a vicious cycle.
Obesity also results in lower levels of sex hormone binding globulin, a protein that carries testosterone around the body, further reducing its availability. Worse still, testosterone helps body cells take up sugar in our diets so low levels predispose to type 2 diabetes and heart disease.
So the number one priority if testosterone levels are low is to lose weight and build muscle.
I'm no expert in muscle building exercise but there is a wealth of great advice on websites like YouTube regarding easy training plans you can follow at home needing no kit other than stuff you're likely to have lying around, so there really is no excuse.
Another important consideration is a different hormone called cortisol.
''Probably the worst form
of exercise for maintaining
a healthy testosterone level is long distance running.''
The more cortisol in your system, the more it inhibits the production of testosterone increasing the risk of all the problems listed above, so it is important to keep cortisol levels down. Cortisol is released in response to physical and mental stress, and helps us deal with it by increasing glucose and energy levels, reducing inflammation, and regulating blood pressure. All very useful when stress is short term, but if stress persists longer term, cortisol levels remain elevated pushing down testosterone. Other causes of persistently raised cortisol levels are depression, insomnia, and exercising too much.
This last one is interesting as earlier in the article I emphasised the importance of losing weight and gaining muscle. The important thing here is not to overdo it. Exercise hard for no more than an hour and preferably every other day, giving plenty of time for a full recovery.
Probably the worst form of exercise for maintaining a healthy testosterone level is long distance running. It increases inflammation, especially in the joints, pushing up those cortisol levels.
So if you want to be healthier, happier, stronger, more energetic, more fertile and generally manlier, think testosterone. Don't allow the modern world to drag you down a spiral of stress, overeating, poor sleep, and physical inactivity, and rob you of one of the most fundamental things that makes you a man.
Richard Brierly studied medicine in London and has spent the last 18 years working as a GP in a small practice in Polegate, East Sussex. He now works as a freelance GP in the Eastbourne area.
Richard is married with three sons, and is particularly interested in the natural world; he loves spending time out in the beautiful Sussex countryside.
He lives in Eastbourne, East Sussex
Other posts by Richard Brierley: