“Testosterone is a short-lived ingredient in the heavenly cocktail, which can be used to improve performance in a multitude of situations, including job interviews, social gatherings, negotiations and presentations. However, you must also keep in mind that it can cloud your judgment and negatively affect your impulse control.” This is how David J. Phillips, coach and communication guru (without health training) sells this hormone in his recently published book, The 6 hormones that are going to revolutionize your life (Planet).
The content of the volume itself, hormones to revolutionize one's existence, gives an idea of what is currently happening with this substance: it is perceived as an elixir. “Testosterone has been considered the hormone of eternal youth,” explains Dr. Juan Manuel Corral, consultant in uroandrology at the Hospital Clínic of Barcelona, to La Vanguardia. To what extent is this consideration correct?
Testosterone is a steroid hormone from the androgen group, which plays a fundamental role in the development and maintenance of male sexual characteristics. Although it is produced mainly by the testicles in men, it is also found in smaller quantities in the ovaries of women and in the adrenal glands of both sexes, as explained in the medical dictionary of the Clínica Universidad de Navarra. “Among its most relevant functions are the promotion of the growth and development of the male sexual organs, the appearance and maintenance of secondary sexual characteristics, such as facial and body hair, a deep voice and the distribution of body fat, as well as the regulation of sexual function and fertility. Testosterone levels are regulated through the pituitary gland, which is a gland in the brain.
As Dr. Corral, who is also general secretary of ASESA, the Spanish Association of Andrology, says, “testosterone plays a very important role in the male body because it allows the development of secondary sexual characteristics, giving it the appearance of a male, and it has a role relevant to fertility. Without testosterone, sperm cannot be produced, and it also intervenes in the conservation of muscle and bone mass, preventing osteoporosis in men, and a series of beneficial effects.”
In the so-called andropause or menopause in men, there is a lack of this hormone. “From the age of 40 or 45 it begins to decrease naturally, with a rate of 0.4 to 1% per year. From the age of 60, approximately 20 or 30% of patients will have levels below normal, and from the age of 80 almost 50 or 60%, says Corral, who adds another consideration. “It is one thing to have low testosterone levels, another thing is to have hypogonadism: this implies clinical symptoms that pose a health problem.”
The decrease in testosterone linked to age “is very progressive and variable, and that makes it difficult to establish if there is hypogonadism. Furthermore, the correlation between symptom levels is not very good: people with low levels of testosterone may not have symptoms, and others with better levels may have more problems,” explains Mireia Mora, endocrinologist at Hospital Clínic and member of the Gónada Group, Identity of Gender and Sexual Differentiation of the Spanish Society of Endocrinology and Nutrition (SEEN).
Factors such as obesity, diabetes or drugs such as opioids and antidepressants can influence testosterone levels, such as corticosteroids or HIV treatment, in addition to factors such as having severe stress or significant weight loss. “These situations can be reversible and temporary, and in these cases you should not intervene with testosterone,” according to Mora.
According to the medical sources consulted, testosterone replacement treatments should only be used in people who have low testosterone levels associated with symptoms, that is, they have clinical hypogonadism. Decreased sexual desire is one of the most common symptoms and the one that generates the most consultations, but not the only one. “Other signs are tiredness, lack of energy, not having the desire to do the things they used to do, loss of muscle mass and bone mass, states of depression, asthenia, diabetes…” says Corral.
In these cases, testosterone replacement therapy can be considered, which can be administered through gels that are applied by hand - in areas of the body where there is no hair - or through a device that helps its extension in the indicated area. . Another route of administration is sustained-release intramuscular treatment—which can last a few months. Gels are the most used format, since they can be easily removed and are easy to dose and vary doses.
For Manuel Castillo, professor of Medicine at the University of Granada and president of the Scientific Committee of the SEMAL, Spanish Society of Antiaging and Longevity Medicine, we can consider testosterone levels specific to each age, and “try to make them a little better or more higher than those corresponding to the range that corresponds to us. A 70-year-old patient can try to have the testosterone levels of a 50-year-old by evaluating the clinical manifestations. His libido, for example, can improve.”
Furthermore, as the endocrinologist indicates, before opting for treatment with this hormone, a pathology that could justify these low testosterone levels must be ruled out. “If there is a problem in the testicle - due to a disease, operation or developmental problem - we would have a cause of low testosterone, it would be primary hypogonadism (because the problem is in the testicle). If the problem is in the pituitary gland, it would be secondary hypogonadism. As endocrinologists we must rule out these situations before giving treatment.”
Testosterone replacement therapy medically or the use of this substance through the black market is increasingly common, not only in older people, but also in the population of 30 or 40 years old, who want to stimulate muscle production, achieve a rejuvenated aesthetic, or improve sexual potency. Even the even younger population makes aesthetic (mis)use of this substance. “6.6% of North American adolescents use or have used testosterone supplementation, according to a recent study. They are not aware that the non-indicated use of testosterone has its side effects,” says Dr. Corral. And not only in young people, but also in older ages, harmful effects are known.
Infertility is one of the main side effects. “When there is a lot of testosterone, the pituitary gland tells the testicle to rest (inhibits its activity), and that produces infertility, because there is less endogenous testosterone, less capacity to produce sperm,” explains Mora. In this same sense, comments Corral, “testosterone is the best male contraceptive. The treatment leaves you infertile if you use it continuously, since it cancels sperm production. What is achieved is atrophy of the testicles, and the person may end up needing replacement therapy for life.”
Other side effects are “an increase in red blood cells, which gives more viscous blood and can be related to a thrombotic event,” says Mora, who adds that cardiovascular risk—risk of stroke or heart attack—is highly discussed. “The evidence is not clear, a study published in The New England Journal of Medicine found that in older people who used testosterone gel, there was no greater risk of heart attack, but there was thrombosis.”
A risk of testosterone supplementation related to prostate cancer has been described. “If the person has incipient prostate cancer, it accelerates, and that is why tests must be done first to check that there are no tumors,” says Castillo, who also clarifies that “there is controversy about whether the administration of testosterone determines the appearance of a new cancer.
Among other possible side effects is also an increase in aggressiveness and risky behavior, to which must be added the risk entailed by the use or consumption of products “that are purchased on the black market.” Depending on the type of preparations, they may be adulterated and poorly controlled,” Mora points out.
“We should not consider testosterone as the elixir of youth. Some of the symptoms may improve, but not others, such as vitality in older people,” adds the endocrinology specialist, who is joined by Castillo with another reflection to take into account. “Treating testosterone deficiency does not mean that one will be better in every way. With age, functionality decreases at multiple levels, but some of these aspects are not linked to this substance,” says the SEMAL specialist.
That is why we must also evaluate the alternatives. In the case of erectile dysfunction, for example, if it is a problem derived from age, “there could be alternative treatments—phosphodiesterase inhibitors, such as Viagra,” says Mora.
