In my recent interview with Hollywood age-management guru, Dr Mike Carragher a surprising fact was highlighted. That younger and younger men are now showing signs of low T, (low serum testosterone and free testosterone levels) starting in their 30s. In fact, their blood lab test can look like a 60+ year old man!
I can relate. Just a few years ago in my late 40s I was a physical and mental wreck. A Bad metabolism including low T along with too many carbs and too much cardio exercise were part of my problem. My wife and I were trying to start a family and things were not looking good. I finally admitted that my old high carb, low fat nutrition and “more is better” exercise habits might be an obstacle This rebooted my motivation to restudy the science to develop a science-based bio hacking system +a natural testosterone boosting protocols (more on that story
here). So far I am not on TRT but if that time comes, I will avail of this option. Now back to Dr Mike and our testosterone boosting chat…
So TRT or testosterone replacement therapy via gels, creams or injectables is hotter each year it seems. Natural testosterone boosting protocols and programs are also a topic with growing interest. This mirrors what appears to be a generalized decline in men´s testosterone levels and longevity + increase in diabetes, obesity and chronic disease.
Many men over 30 with low testosterone levels note their energy, strength, muscle mass, body fat, sexual function and memory isn’t what it used to be. These are some of the reasons why doctors prescribe TRT or testosterone replacement therapy. Doctors and health and fitness experts also suggest targeted lifestyle improvements.
The targeted science-based lifestyle improvements have a synergistic metabolic effect to improve how you look, feel and perform at home, work and sports. Nutrition, sleep, stress, supplements, mindset and exercise are among the cornerstones of my new Metabolic Vitality 14 Day Reboot program. Let us know if you want in on the early bird list.
Of course, you will hear lots of different opinions, many based on outdated ideas and even a now debunked study that some thought linked prostate cancer with testosterone. For a deep-dive look at the science involved in this issue see the book Testosterone for Life: Recharge Your Vitality, Sex Drive, Muscle Mass from a Harvard doctor and a leading expert on testosterone– Abraham Morgentaler, M.D., at Harvard Medical school.
Dr Morgantaler´s book will give you the peace of mind about the safety of testosterone that has been polemical and unclear at least to some conventional doctors. In fact having low level of testosterone can increase health risk as well as lead to a limited life of low vitality.
Personally, since I entered the wellness and health field in 1989, I have known and coached hundreds of busy men. Many after getting their lifestyle dialed in with a tailor-made Metabolic Vitality lifestyle habits plan benefited from TRT along. That said, studies of the risks and benefits have been mixed, and the Food and Drug Administration beefed up its warnings about possible negative side effects of testosterone therapy n in 2015.
And the findings of five studies released Tuesday aren’t likely to clear up the confusion. They appear in JAMA, the journal of the American Medical Association and JAMA Internal Medicine.
The studies are collectively called the Testosterone Trials (TTrials) and they compared a testosterone gel, AndroGel, against a placebo. The results are based on 788 men with below normal levels of testosterone studied at 12 sites across the country over a year.
Overall, researchers saw improvements in bone density and bone strength in men who used a testosterone gel, which raised their testosterone to levels seen in younger men.
In men with unexplained anemia, testosterone also improved iron levels in the blood. (A reviewer of the study raised questions about whether it was done ethically.)
Taken together, says Dr. David Handelsman of the University of Sydney and Concord Hospital in Australia, the TTrials “do not materially change the unfavorable balance of safety and efficacy to initiate testosterone treatment.” His comments appear in an editorial in JAMA.
“Low testosterone levels due to obesity” and other aging health problems, Handelsman says, “are better addressed by lifestyle measures” directed at those problems. He also called for strengthened warnings on the drug’s packaging to note the cardiovascular risk.
In another accompanying editorial, Eric Orwoll, a professor of medicine at the Oregon Health and Science University, says convincing answers about the effects on cardiovascular health remain “elusive” and will require large, prospective randomized trials.
“At this point, clinicians and their patients should remain aware that the cardiovascular risks and benefits of testosterone replacement … have not been adequately resolved,” he says.
The mixed research results
Indeed, a T trial published Tuesday, which was not part of the TTrials, showed a lower risk of cardiovascular events, including heart attack or stroke, in men who’d received testosterone, on average, for 3.4 years. The red flag on cardiovascular risk was raised in the TTrials’ Cardiovascular Trial, where researchers found an increase in plaque buildup, a known risk factor for heart disease. The study was based on 73 men using the gel and 65 receiving a placebo. The study was originally done because there had been suggestions that testosterone has heart benefits.
Even more positive results were seen in the TTrials’ Bone Trial. Among men using the testosterone gel, there were statistically significant improvements in lumbar spine and hip bone density and bone strength. There was a small and equivalent number of bone fractures in each group. The Bone Trial included 189 of the 790 men in the overall study.
But another TTrial, the Cognitive Function Trial, failed to find improvements in memory and cognitive skills associated with testosterone treatment. This trial studied 493 men who had age-associated memory impairment at the start of the study, as measured by subjective memory complaints and objective memory performance.
The TTrials started out by screening more than 51,000 men 65 and older. To qualify for one of the subtrials, men needed a blood level of testosterone to be below 275 ng/dL, just below the range many doctors consider “normal” for healthy, younger men.
After screening, 788 men were considered to have low testosterone.
Until the first year of TTrials was over, neither the participants nor the researchers knew which men were getting the placebo or the testosterone gel.
The first set of TTrial studies was reported last year in the New England Journal of Medicine. Those looked at sexual function, physical activity and mood and found that sexual function and desire did improve significantly among men using the testosterone gel.
Some mood improvements were also noted although there was not significant improvement in overall vitality or in physical activity.
Final decisions about testosterone treatment for older men will depend on “balancing the results” from the TTrials “with the results from a much larger and longer-term trial designed to assess cardiovascular and prostate risk,” says endocrinologist Peter Snyder of the University of Pennsylvania, who headed the studies.
In the meantime, TTrial researcher Susan Ellenberg says decisions about whether to take or not take testosterone should be made between older men and their physicians, taking into account overall health and medical history while weighing potential benefits and risks.
The studies were funded by the National Institute on Aging and other parts of the National Institutes of Health. Additional funding was provided by the maker of AndroGel, AbbVie, which also supplied the drug, which is customary in clinical trials. The company was not otherwise involved in the implementation or analysis of the trial.