By Thomas O’Connor, MD 
Is it true? With all this hype on men turning into women, I decided to take some time and do some of my own research on this topic for myself- here is what I found.
A recent, well done study peers into what is going on with men and low testosterone.
The study, published in The Journal of Clinical Endocrinology & Metabolism discusses the detailed nature of “who is” and “what is” going on with men losing their testosterone:
“Low levels of testosterone impact many aspects of male physiology,” lead author Andre B. Araujo, a research scientist at the New England Research Institutes in Watertown, Mass., said in a prepared statement. “This is particularly significant because the ongoing aging of the U.S. male population is likely to cause the number of men suffering from androgen deficiency to increase appreciably.”
New England Research Institute scientists analyzed data from almost 1,500 men enrolled in the Boston Area Community Health Survey. The survey tracks people aged 30 to 79 years and compiles data on factors such as testosterone, symptoms of hormone deficiency, and medications that may impact sex hormone levels.
Approximately 24 percent of the men surveyed had low total testosterone and 11 percent had low levels of free testosterone. Many of the men had no symptoms related to their low testosterone.
About 5.6 percent of the men in this study suffered from symptomatic androgen deficiency. Older men were especially prone: over 18 percent of men over age 70 met the criteria for this deficiency.
Based on these results, the researchers predict that by 2025 there may be as many as 6.5 million American men between 30 and 79 years of age with symptomatic androgen deficiency, an increase of 38 percent from the year 2000 population estimates.
“This study did not assess whether men with symptomatic androgen deficiency are good candidates for testosterone therapy,” said Araujo. “Well-designed, randomized, placebo-controlled trials would be needed to address the risks and benefits of testosterone therapy.”
If these experts are even approximately close, it appears that we do have an epidemic of Low-Testosterone, AKA Low-T on our hands! Now the question is what has happened and more importantly, what can we do about it? Low-T is a medical condition that robs men of their drive for life- including sex, mood and vitality. This medical state can commonly lead to poor organic health and depression in addition to a shortened life-span, so we better pay attention to what is going on!
low testosterone in men
What has happened?
Most importantly, we have to understand the data that has led to these conclusions. It is true that these studies have not been the best in terms of statistical methods, but there is overwhelming clinical and anecdotal data to support that something is wrong and where there is smoke, there is likely fire!
We have known that men start to lose their “laboratory” testosterone levels of about 1% per year after the age of 30. This does not mean that all middle aged men are “hypogonadal” or have Low-T clinically. These are only numbers on a lab chart. Men are not numbers or statistics living on the pages of medical studies, but this data helps us as physicians assess where a man is clinically in terms of having Low T. After more than 15 years diagnosing and treating men for Low-T, I am amazed to see the clinical variation in terms of symptoms vs actual lab testosterone levels. What I am saying is that there are plenty of men that present with a lower testosterone lab value, yet not all of these men complain of the required clinical symptoms that would diagnose him as having Low-T. On the other hand, I have seen an equally impressive number of men who present to me with “normal” testosterone lab values who are clinically hypogonadal and have Low-T. Hence the requisite for the astute clinician.
These studies are starting to get down to the clinical features of who has Low-T, why and of course, who should be treated. It is the clinical features that have turned upwards the brows of these scientists, including me. It appears that men are starting to talk about how they really feel in terms of their sexuality, mood, energy and are expressing that they want help! It seems that finally, men are starting to talk! I can tell you that in my private medical practice, in which I have taken care of thousands of men since 2005, older men, over the age of 75 will NEVER complain about anything!! These are the stoics, the hardy men!! Men that have come from true and absolute hell. These guys were born during or before WW2. They grew up broke, fighting for life with a lot of brothers and sisters. America was united and there were no distractions of modern media. These guys were not designed to “share” their feelings and as such to suffer in a silent dignity-just how these guys roll! Trying to ask about how sex is with these guys- I’d rather try to pull a tooth out of their heads!! Then came the Baby-boomers- a bit more talkative and now the cat is out of the bag! Men are talking it up big time! This has shown up on the radar screen in the studies of Low-T.
In my professional and personal opinion, I think this is what we are now seeing in terms of the “new” uptick in men with Low-T. Now, we are picking up much more of the clinical symptoms of men that may relate to having Low-T. These symptoms have probably always been there, but because of the population of men being interviewed, it was never detected. In addition to this, it is possible that the modern era has caused Low-T in an organic way. With a growing obesity epidemic, exposure to xenoestrogens- plastics, cosmetics, toiletries (ever think of what that underarm deodorant is doing to your testosterone level? 
Did you know that there is actually a very popular type of topical testosterone that men rub on their underarms?!!).
Even in our food supply, we have evidence of estrogens secondary to insecticides, herbicides and even high energy waves from electrical wires, cell phones and radio wave towers are implicated in today’s feminization of men! We can also look at our diets- high in GMO and processed foods that can lead to significant deficiencies in zinc and other minerals, excess stress and elevated cortisol levels and lowered DHEA levels, head trauma and chronic medical disease can lead to a Low-T state. Here is some of the most common medical conditions that can lead to Low-T:
Diabetes and pre-diabetes (insulin resistance)
Obesity
Chronic illness
Depression (careful evaluation as Low-T can cause depression)
Opioid drug use long-term
Alcohol in excess
Corticosteroid use
Anabolic steroid use and Anabolic Steroid Induced Hypogonadism-ASIH
What to do? 
With all the hoopla surrounding Low-T it’s hard to truly understand who has this medical condition and what to do about it. Of course there are clinical practice guidelines provided by various expert medical societies and most agree that there has to be a balance of clinical symptoms related to organic medical disease state(S) in addition to laboratory evaluation. This means that a man has to present to his doctor with classic symptoms associated with Low-T, such as malaise/fatigue, poor sexual libido and most likely erectile dysfunction, have a medical condition such as obesity and diabetes or pre-diabetes in addition other medical conditions relating to Low-T (see list). All of the expert guidelines agree that the most important clinical feature to focus on are symptoms relating to a man’s sex drive and sexual performance.
This data has to be evaluated by an expert physician to decide if a man is a candidate for a trial of physiologic testosterone replacement. This process is a very personal one and each man needs to be given proper time to discuss with his doctor what is going on regarding his symptoms and how it may or MAY NOT relate to a Low-T state. As I said above, some men have lower T lab values, but have “OK” sex lives and will not benefit from testosterone replacement and reciprocally, there are men that have low normal and even at times normal testosterone levels that may benefit from a trial of testosterone replacement. Men who have used anabolic/androgenic steroids in the past are the most common who fall into this latter category.
Men should also be counseled on their medical issues and that in many instances if he can improve his health, commit to sustained weight loss through diet and exercise, his symptoms that he thought may have led to a Low-T state can be reversed!
Laboratory tests for men to diagnose men with Low-T:
CBC- complete blood cell count
CMP- comprehensive metabolic panel
LIPID PANEL- total cholesterol, LDL, HDL and triglycerides
HA1c- hemoglobin A-1C
UA- Urine analysis
TSH- thyroid stimulating hormone
PSA- prostate specific antigen
Total and Free Testosterone (LCMSMS) done in the am and can be repeated
LH and FSH
Total Estrogen
Vitamin D
Summary– Starting testosterone as a medical therapy should be taken very seriously! There are risks and some of these have not been fully elucidated at this time and remain controversial. I always use Evidenced-Based- Data to explain each step of the diagnosis and management aspects of men I work up and Rx testosterone to and you should DEMAND that you see ONLY a board certified expert with years of clinical experience in diagnosing and managing men on testosterone.
Stay strong and healthy,
Dr O
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