Feeling tapped out. Foggy. Just not all that into sex. Gotta be your testosterone, ads would have you believe. And we’re believing it, too, with the number of T-supplement users tripling from the early 2000s through 2016.
Don’t get us wrong: Testosterone is one critical hormone. Babies first encounter it in utero, when it triggers the differentiation of boys from girls. In puberty, it contributes to your bone growth and muscle mass, and continues to affect functions including your red-blood-cell production and mood stability.
But the message those ads are sending plays right into the economic and social anxieties men are facing. It’s like when anti-anxiety meds such as Valium first came onto the scene, says urologist and MH advisor Elizabeth Kavaler, M.D. “All these middle-aged women were addicted to Valium, because that was the solution to everything. Testosterone has become the new answer for a life of quiet desperation.” More and more of us are feeling the exhaustion of uneasiness. We are being asked to do more with less. We’re just trying to get through the day alive. “Men think, Well, if I just get a little testosterone, I’m going to feel great!” Dr. Kavaler says. “And that’s not the case.”
There’s so much information out there about T—much of it speculation and lore—that leads us to jump to conclusions about it. Men put all kinds of psychological weight on their testosterone number—a low one makes you think you’re somehow less manly; a high one means you’re basically LeBron James—and that’s where we get things wrong. There’s little evidence for those stereotypes. Low doesn’t automatically imply you’re weak or retiring; high doesn’t guarantee you muscles, aggressiveness, or MVP athletic performance.
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A low number might not even be a low number for very long. It might just indicate that you haven’t been treating yourself very well. As long as your T is in the normal range, there’s nothing about a high number that’s better than a low one, or vice versa.
In the name of science and good journalism, I got my testosterone tested twice while writing this story. It put my assumptions up against a pretty big test, too (more on that later).
What do you really know about this famous hormone? Here, we break down the best and latest information to give you the clearest picture yet of what T means for you. And whether, maybe, you should be taking testosterone after all.
HOW WOULD YOU KNOW IF YOUR TESTOSTERONE WERE LOW?
As many as 5 million men in the U.S. (generally older men) do actually have low levels of the hormone. To know if your testosterone is low, first see if you have any symptoms, which include: erectile problems, lack of energy (never feeling rested, no matter what you do; having a paunch; an AWOL libido (not just not wanting to have sex on a Thursday night after a crushing week, but lack of the kind of base-level sex drive wherein you get turned on by the sexy person you spot on the street, explains Tobias Kohler, M.D., of the Mayo Clinic).
HOW TO FIND YOUR TESTOSTERONE LEVEL (IT’S TRICKIER THAN YOU THINK)
With testosterone, as with life, normal is nuanced. And fraught (but shouldn’t be). To get an accurate reading, you should have at least two tests, since testosterone is constantly in flux. It peaks in the morning, so if you’re young and on a typical sleeping schedule, aim to be tested by 10:00 a.m. If you’re over 50, it doesn’t matter as much.
Be aware that your level can be affected by certain social factors and health habits. In the new book Testosterone: An Unauthorized Biography, scientists Rebecca M. Jordan-Young and Katrina Karkazis point out that T levels even respond to social factors like feedback. For instance, rugby players who watched video of good game plays and got positive feedback had up to a 50 percent increase in T compared with guys who were shown their mistakes and received critical assessments.
Resistance training can also give you a short-term boost in testosterone. Cardio doesn’t elevate T levels as much in normal-weight men, says Jesse Mills, M.D., the director of the Men’s Clinic at UCLA. But here’s the thing: Jordan-Young and Karkazis dug through the research to find that T levels alone don’t deserve the credit when it comes to an athlete’s performance. And cutting sleep short and taking multivitamins with biotin can push testosterone levels down (skip the vitamins for three days before testing).
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So get your tests on days that are typical for you. And when you get your number, don’t read too much into it. A T level of 264 to 916 nanograms per deciliter of blood is generally considered normal. If you are close to 264 and you feel fine, then you’re no less healthy than a guy whose level is 700 and also feels fine. (There’s an exception to that, though: If your T level is below 300 and you have low-T symptoms, then docs would consider you in a low-T category)
Not reading into it is harder than it sounds. I got my first test at the tail end of a busy week. I’d slept less than five hours the night before, then scrambled to the phlebotomist in a daze. My number: 287. That’s in the normal range, but just barely. I have no symptoms of low T, but it was hard to shake the feeling that there was something wrong with me, even though I know that normal is normal, no matter where it is in that range. Eleven days later, I was tested again. My number was 429. Why such a dramatic change? It might be because I’d slept better and cut out my multivitamins.
Irrational or not, I felt like more of a man. The whole experience was a microcosm of our relationship with T. We act like it’s destiny, but it’s just biology—easily misunderstood and more varied than we think.
3 COURSES OF ACTION IF YOU HAVE LOW TESTOSTERONE
The single best thing you can do to improve your level is be healthier. Avoid stress, get more sleep, and lose weight—an enzyme in fat tissue converts testosterone to estrogen. That’s one reason flab can lower your T. It’s also why overweight guys can develop man boobs, and why bodybuilders who juice can also develop man boobs—they don’t have much fat, but they’ve jacked their T levels so high that there’s a lot of it available to be turned into estrogen. Thinking of T strictly as “the male sex hormone” oversimplifies the complex hormonal interactions that make our bodies work. Which is also why, if you can avoid it, you don’t want to go with the needle-in-the-butt routine to raise your T.
But that might not work. If your level is low enough to warrant more aggressive treatment, your doctor can prescribe a drug that causes your pituitary to tell your gonads to make more testosterone. The typical choice is clomiphene citrate (Clomid), a common fertility drug for women. Using it doesn’t exempt you from needing to get healthy, though, as it doesn’t diminish the risk of losing T to bad sleep and a beer belly.
Then there’s always testosterone-replacement therapy, which should be your last resort. (When you give your body T, it stops making its own, and there’s no guarantee it can start again.) If, though, you and your doctor decide it’s the way to go, you’ve got options. You can try a testosterone replacement gel, a topical that’s easy to use but can rub off on your partner or kids. There are pills, which are even easier to use than the gel and can deliver higher levels. There’s subcutaneous pellets, or rice-sized inserts that live directly under your skin. And then there’s that needle in the butt, which can provide a major boost but is generally only used by docs who specialize in testosterone therapies.
Whatever you choose, be glad that we’ve moved past the early days of replacement therapies, like one in the 1920s that involved transplanting goat testicles into patients. Believe it or not, it didn’t work, and it also didn’t make anyone feel like more of a man.
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