Low Testosterone or Marketing Hype?

You may have seen advertisements on TV for a site called IsItLowT.com which report many signs and symptoms of low testosterone such as low energy, weight gain, depression, etc.  IsItLowT.com is owned and operated by Solvay Pharmaceuticals (now owned by Abbott), makers of AndroGel, a rub on cream used for TRT or testosterone replacement therapy.  You'll notice if you go on there site and visit the "What you can do section" testosterone cream is the first recommendation they make.  AndroGel is testosterone base, without any modification to the molecule, in a transdermal carrier.  It can cross through the skin and into the blood stream, but it is generally an expensive option and blood levels aren't maintained as they are with injectable testosterone.  The gel also only comes in packets of 5mg dosage for a one day application.  Since the average male produces between 2-11mg of testosterone per day naturally, an additional 5mg is not going to account for much - and it is definitely not going to assist in the area of muscle building or body composition.  However, blood levels of testosterone from AndroGel throughout the day are maintained over a 24 hour period. This is also an improvement over previous testosterone patches which had to be placed exclusively on the scrotum.  AndroGel can be rubbed in pretty much anywhere.

Below is a copy of my misaligned scan from William Llewellyn's Anabolics 2005 book showing steady state testosterone concentrations in the blood from 30 days of using 10g AndroGel daily.  As you can see, blood levels of testosterone stay stable throughout the day, but as we will see below, it far under performs when looked at side by side with injectable testosterone with added esters.

TRT is a very popular treatment amongst athletes and bodybuilders, because it essentially gives them a legal means to get testosterone.  One of the more popular TRT therapies advocated is American made Upjohn testosterone cypionate at 200mg/week.  An average steroid "cycle" when used by a bodybuilder will be on the scale of anywhere from 500mg to 1000mg of testosterone per week, combined with other AAS (anabolic androgenic steroid) in a "stack" to add synergistic effects from the other compounds and promote whatever goal the athlete has in mind.  Some of these products can be from dubious sources, since all AAS are scheduled in the US, the athlete has to find them on the black market.  These will come from veterinary labs, where the products are legitimately made for animals (there is no biological difference between animal and human steroids, they both work the exact same way and can be switched from mammal to mammal).  Or some where the products are claimed to be made for animals, but it is actually produced to be sold to underground steroid suppliers claiming to be affiliated with vets as a cover.  There are also many home brew steroid "underground labs" that buy bulk raw pharmaceutical AAS material from China and then package it themselves for redistribution.  Both of these methods can come across problems with quality control and lack the common safety that USP grade drugs available with a prescription do.  So, when a bodybuilder has the prospect of being able to take steroids safely, under a doctors guidance, in a legal setting, and maybe even let insurance cover it, the choice is obvious.

The most commonly prescribed form of injectable testosterone for TRT is testosterone cypionate, as mentioned above, at 200mg per week.  When looking at concentrations of blood levels using testosterone cypionate, we can clearly see the benefit of once a week dosing, but that it is a much higher level of testosterone in the body.  Cypionate is an ester that is bound to unmodified testosterone and added to an oil solution.  Once injected it forms a deposit site under the muscle where it is slowly moved out of the oil and the ester groups begin to cleave off at varying rates (in this example, generally over a period of 2 weeks).  Here is  another diagram from Anabolics 2005 showing the pattern of testosterone release after the first injection on day 0 and how it tapers after about 10 days.

Benefits of TRT

As men age their bodies do slowly start to produce less and less testosterone.  But there are other reasons too, such as poor diet, weight issues, depression, and certain medications.  We are also becoming more and more aware of compounds know as xenobiotics, phylates, and endocrine disrupters that could be potentially causing our male populations gonads to dry up.  Although this is a subject for another article.

Increasing testosterone within a supraphysiological dosage can have many positive benefits, including reduction in fat storage tissue, energy, focus and concentration from increased DHT in the brain, increased libido, sexual drive and stamina (obviously the main functions of these sex hormones) and more.

Determining whether or not you qualify to be considered for TRT is based on your current testosterone levels and your age in some cases.  The first step is to take a full panel male blood test to see where your testosterone levels are at, and make sure you don't have risk factors for prostate cancers or other issues that can come up when using supplemental testosterone.

But it's not all good news

Doctors and scientists who recently reviewed the IsItLowT site for Reuters came to some alternative conclusions.

Iheanacho and Matsumoto said separately that the symptoms described in the [IsItLowT marketing] campaign are "nonspecific," and could be linked to diabetes, circulation problems, or depression, as well as aging. The Low T site does say that the problem is more common in diabetics and the overweight.

"If someone is low in energy and is 65, that might be entirely compatible with his general life and -- let's face it -- decline," Iheanacho said. "It would be entirely normal."

The endocrine group's guidelines, which appear in the June issue of the Journal of Clinical Endocrinology & Metabolism, say doctors should only make a diagnosis of low testosterone "in men with consistent symptoms and signs and unequivocally low serum testosterone levels."

[...]

The treatment isn't without peril. The Endocrine Society said it's not recommended for men with prostate cancer or for African-American men with fathers, brothers, or children with prostate cancer. In 2009, the Food and Drug Administration required that testosterone gels be labeled with a prominent warning after repeated reports that young children showed signs of early puberty after being exposed to it, typically through skin contact with their fathers. (italics added)

So, yes, many of the symptoms described by the IsItLowT campaign could be attributed to other illnesses, diseases and problems.  It is also important to note, a fact of which I myself was not aware, was that getting the testosterone creams and gels in contact with children can cause early onset of puberty!

But, a full panel male blood test will always help determine whether or not you have low testosterone and could potentially be a candidate for TRT.  It also helps identify potential risk factors that could be going on at the same time, making a blood test a win/win either way.  The one thing you can be sure of though, is you don't need to waste your money on any of the over the counter testosterone boosting supplements.

UPDATE 8/6/2010: Almost as soon as this article went up, Reuters posted a new article shedding some doubt on the entire hypothesis of "male menopause"

For many middle-aged and elderly men, low libido, depressed mood and a lack of energy may just be the signs of normal aging -- and not low testosterone levels.

That's the conclusion of a new study that found only about 2 percent of men between 40 and 79 would qualify for a strict diagnosis of so-called late-onset hypogonadism, sometimes called "male menopause."

Earlier studies had indicated the diagnosis was much more common, and millions of prescriptions are written every year in the U.S. to help men with "Low T," as one drugmaker refers to the controversial condition. (See Reuters Health story June 8, 2010.)

Based on a random sample of more than 3,000 European men, British researchers found that only three symptoms -- fewer morning erections, fewer sexual thoughts, and erectile dysfunction -- were consistently related to low levels of the male sex hormone.

Read the full article: Doubts cast on "male menopause" criteria (Reuters)

Sources
1.  Llewellyn, William. Anabolics 2005. Body of Science Publishing, Jupiter, FL.  2005
2. Dillion, John.  Do you have 'Low T?' Or is it just hype?  Reuters, New York, New York.  6/8/10