Men’s Health: Reversing
Testosterone Loss
By Paul D. Tortland, D.O. T
estosterone. The mere word conjures images of steroid-drip- ping, weight pumping, oversexed, ‘roid-raging muscle heads. It is much less likely to convey images of bone density, mental
concentration, and protection against cancer and Alzheimer’s dis- ease.
The Aging Male
Before we discuss the role of testosterone replacement, let’s review what happens to men as we age.
Between the ages of 40 and 50, men will lose 2-5% of their lean muscle mass. From age 50 onward the loss accelerates, averaging 1-2% loss per year. By age 80, the average male has lost 25% of his lean muscle mass. Though sobering, most of this loss is preventable. Loss of bone density is a condition most commonly associated
with women. However, men also suffer from decreased bone density and can develop osteoporosis. Bone density peaks at around age 30 then gradually declines. This decline likewise can be prevented, but any loss sustained cannot be replaced. Aging also brings changes in body composition. A gradual increase in body fat starts at about age 25. This is not necessarily due exclusively to weight gain. Rather, it can be due to a progressive loss of lean muscle mass. Finally, testosterone (T) levels begin to decline an average of
1.5% per year starting at age 30. Though part of the natural aging process, testosterone loss can be associated with certain medical conditions, including chronic pain (opioid use decreases testoster- one levels), cardiovascular disease, obesity, and diabetes.
Testosterone Physiology Testosterone is an androgenic steroid hormone derived from
cholesterol and produced by the testes in men (and by the ovaries in women). Men produce 7-8 times more T than women, though women are more sensitive to the hormone. Testosterone has anabolic and androgenic effects. The anabolic effects include increased protein synthesis leading to growth of muscle mass and strength, as well as increased bone density and
12 Natural Nutmeg June 2012
bone strength. The androgenic effects include the development of secondary sex characteristics and growth of body hair. In addition, testosterone is essential for general health and well-being, as we will detail later.
As is the case with most hormones, T is not very soluble in blood. In order to be transported in the bloodstream to target areas, hormones need to be piggybacked, or bound, to carrier proteins. As a result, T is found in two forms, bound and unbound. Blood test re- sults report both the total T level, representing the combined bound and unbound portions, and the free T, comprising only the unbound portion. Only the free, or unbound, portion is biologically available to be used by the cells. As we age, decreasing T levels are due primarily to a progressive
failure of the hypothalamus (a small gland at the base of the brain) to stimulate production of testosterone. It is generally not due to a primary failure of the testicles.
Hypogonadism is the term used to describe the symptoms of
decreased T production. However, one can have clinically low T lev- els without clinical symptoms. This is known as hypotestosteronism. Why is this distinction worth mentioning? The symptoms of hypogo- nadism are what push men to seek medical attention (and sometimes spur the women to push the men to seek attention!). However, as we shall see, low T levels, even without overt symptoms, increase the risk of other conditions as we age. Therefore, an argument is made for optimizing T levels from a preventive medicine and wellness perspective, even in the face of no symptoms.
Disease and Testosterone
Although aging is the most common cause for declining T levels, a number of medical conditions are closely associated with low T. Conversely, many disease states can be improved, or at least the as- sociated risk factors mediated, by increasing T levels. Obesity is a major cause of low T. Men who are 20% over
their ideal body weight (e.g., 204 lbs for a 170 lb man) have 25% decreased total T levels and 19% lower free T levels. This situation worsens with greater obesity. Body weight 200% above your ideal is associated with a 60% reduction in T levels. This is because fat
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