Low Testosterone in Men Poses Serious Risk

John Walker, M.D. Gastroenterologist & NSI Scientific Advisory Board Member July 18, 2008 - While it is well known that women experiencing a change of life due to fluctuating hormones are at increased risk for serious health concerns, it has recently been revealed that men also experience hormonal shifts around mid life. If left unchecked, decreased levels of testosterone in men may pose critical health threats, ranging from plummeting energy levels to some that may even prove fatal.

Deficiency in the male sex hormone, testosterone, has been getting a lot of attention recently. While most of us are aware of the decrease in sex hormones that women experience (menopause), most people are unaware that a similar phenomenon called andropause can occur in men.

This testosterone deficiency can lead to a number of symptoms, including poor mood, loss of stamina, decreased muscle mass and decreased libido. The problem is it occurs so slowly that it often goes unrecognized. In fact, testosterone levels may start to decrease in a man's mid 30's, and by age 80, they may be reduced by 80%. While the associated symptoms are a problem, the bigger issue may be increased mortality related to the low testosterone levels.

A recent study¹ presented at the Endocrine Society's 90th Annual Meeting in San Francisco looked at the relationship between testosterone levels and death from all causes. During this study, which took place in Germany, testosterone levels were measured in 2,000 men aged 20 to 79. It was found that 5% of these men had low levels of testosterone. The subjects were followed for an average 7 years, and death from all causes was recorded.

The study found that men with low levels of testosterone had a 2.5 fold (250%) greater risk of dying in the next 10 years than men with normal levels. Specifically, low testosterone levels appeared to predict and increased risk of death due to poor cardiovascular health and abnormal cell health. Subjects were matched for age, smoking, alcohol intake and level of physical activity. Risk factors for diabetes and heart disease were also determined to be similar between the two groups.

Clearly, this is concerning. Any risk factor for increased mortality that can be modified should be taken seriously. However, over the years, testosterone supplementation has gotten a bad wrap. While it is true that testosterone is a member of the class of hormones known as anabolic steroids, the therapeutic use of this hormone should not be equated with the over dosage, illegal and reckless use of other agents that have tainted professional sports.

There is a large body of medical literature suggesting that testosterone supplementation can be safe and effective for the above mentioned symptoms, and may even be life saving. In fact, in a 2007 review², Drs. Miner and Seftel reported that low levels of testosterone were associated with a variety of health problems, including metabolic syndrome, whereas supplementation could help reverse this process and contribute to other health benefits, including improved bone health and metabolism.

One common concern is the effect testosterone has on the prostate. Several studies have shown that in men with a normal prostate, testosterone replacement may have beneficial effects, and does not appear to change the gland itself. However, men with prostate cancer should never take supplemental testosterone, or use supplements that may have this effect.

So what are your options? First, you can have your testosterone level checked. Testosterone comes in two varieties, free testosterone and total testosterone. Free testosterone may be the most active form, and the total testosterone test may not accurately reflect the amount of free testosterone. And as you may suspect, it is the level of free testosterone that drops more quickly. One method of combating this drop in free testosterone is supplementing with DHEA.

Some studies suggest that DHEA levels parallel free testosterone, and that supplementation with DHEA may increase free testosterone levels. There are also numerous published studies indicating DHEA is safe and promotes healthy blood DHEA levels. The typical dosage for a man is 50 mg per day and for a woman 15 - 25 mg per day, this is to achieve levels of a typical 25 year old person. DHEA is best taken in the AM about 20 minutes prior to breakfast.

There is some research suggesting that the herb nettle may displace testosterone from the bound form (which makes up most of total testosterone) and allow it to circulate in the more active, or free, form. This may promote healthy libido and sexual health. Another benefit of nettle is its affect on the prostate. It appears to block the conversion of testosterone to DHT, the metabolite that may be responsible for poor prostate health in many men. Interestingly, elevations of DHT are also thought to be a major cause of thinning hair and baldness as men age.

You may know that bodybuilders rely on testosterone, and other steroids, to achieve increases in muscle mass. They frequently use Tribulus terrestris to help promote healthy levels of testosterone. The evidence on this is sketchy, and while there is a lot of anecdotal positive customer review, I would like to see placebo controlled studies conducted.

Another factor to consider pertains to counteracting hormones. Estrogen, the main female sex hormone, is also produced in men. Some men, especially the obese, produce too much of this hormone. This may antagonize the effects of testosterone.

DIM (diindolylmethane), is a plant compound found in cruciferous vegetables such as broccoli, cauliflower, cabbage, kale and brussel sprouts. There is some evidence that DIM may play a part in supporting a healthy balance of estrogen and testosterone levels in both women and men. DIM may promote healthy estrogen metabolism by diminishing unmetabolized estrogen, known as estradiol. Elevated estradiol levels may lead to moodiness and breast pain in women and decreased sex drive in men.

DIM may also help reduce active estrogen from the male body, promoting more free-circulating testosterone in the bloodstream. Higher levels of testosterone and lower levels of estrogen are associated with lean body mass, efficient fat-burning metabolism and healthy abdominal weight.

Another supplement that works in a similar way is chrysin. This herb also appears to promote the metabolism of estrogen, making it less available to antagonize the effect of testosterone.

You should work with your physician to test your testosterone and find out if you are a candidate for FDA approved pharmaceutical testosterone replacements. If you are, these supplements may help promote your good health. As I mentioned above, if you have prostate cancer, you should not take supplemental testosterone, or use supplements that boost DHEA or testosterone.

I also recommend vitamin D3 at 2,000- 4,000 IU per day, lycopene at 10 - 30 mg per day in the standardized LycoMato® form, selenium at 200 mcg per day in the selenomethionine form, zinc at 15 – 30 mg per day in the L-Opti-Zinc® form for everyone. If you are a man with prostate concerns I would also add standardized saw palmetto at 320 mg per day and standardized nettle at 240 mg per day.

One of my favorite supplements to promote healthy prostate function containing many of these exact nutrients and dosages is Nutraceutical Sciences Institute® (NSI®) ProstaHeart™ softgels. It has numerous standardized nutrients proven to promote healthy prostate and cardiovascular health. Another good option is NSI's Prostate Formula. My favorite brand of DHEA is NSI's, as they provide 300 50 mg time released capsules for under $25. Read the customer reviews, 100% would recommend it and the average rating is 4.8 out of 5 stars.

1. Haring R, ENDO 2008: The Endocrine Society 90th Annual Meeting: Abstract OR35, presented June 17, 2008.

2. Miner MM and Seftel AD, Testosterone and ageing: what have we learned since the Institute of Medicine report and what lies ahead?, International Journal of Clinical Practice, April 2007, 61(4):622-32.

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