Perhaps because Big Pharma finds its erectile dysfunction medications going into generics, it has recently begun to tell men over 40 that their normal signs of aging are a pathology, the product of low testosterone. In its knack for catchy euphemisms (like “E.D.” for the less savory “impotence”), Big Pharma tells us that “Low T” renders us ghostly shadows of our former selves, for which testosterone supplements will offer the remedy.

Gay, bisexual, and transgender men may be particularly susceptible to this marketing. Our popular queer culture amplifies the youth orientation of American consumerism, extolling sexual prowess and buff physique. Indeed, lower testosterone is associated with increased body fat and reduced sexual drive and energy, as well as lowered muscle and bone mass, and increased erection problems and depression.

What is “normal”?

However, there are problems both with both the diagnosis and the “cure.” First, what is a “normal” measure of testosterone? That range is quite broad, from 300 to 1,200 nanograms per deciliter. Without knowing your baseline testosterone level, what constitutes a deficiency? Moreover, testosterone levels vary across a single day, usually higher in the morning. Unfortunately, many people are prescribed testosterone therapies without diagnostic or follow-up blood tests.

Causes of reduced testosterone

Second, symptoms of reduced testosterone may have a variety of causes, including medications and illnesses. Measurably reduced testosterone may have one or more causes: tumor, inflammation, or genetic disorder. Excess body fat, type 2 diabetes, as well as use of steroids and analgesic opiates are also associated with reduced testosterone.

Risks of testosterone therapies

Third, taking testosterone supplements is not without its risks. Use of testosterone supplements is associated with an increased risk of cancer of the prostate and breasts. Both of these prospects are important to keep in mind for people born as biological males (i.e., with prostate glands) or as biological females who are transgender female-to-male. Although most males who live long enough will develop prostate cancer, testosterone supplements  can stimulate cancer tumor growth. Moreover, testosterone supplement use has been associated with heart disease. A study published earlier this year in PLOS One identified an increased probability of heart attacks among older men who had used testosterone supplement therapies: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0085805

Conclusions

There are worse things in life than aging and its normal effects. Reduced testosterone later in life may bestow an evolutionary advantage, protecting people born male (with prostates) from the increased probability of prostate cancer. Transgender female-to-male patients should understand and be monitored for the increased risk of breast cancer. As the Institute of Medicine’s 2011 report on sexual minority health observed, threats to transgender health are insufficiently researched and incompletely understood. http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx

The healthiest prescription you can have for lower testosterone is to manage weight through diet and exercise (both aerobic, which builds stamina, and resistance training, which builds muscle and bone mass). Because alcohol can reduce testosterone, limiting alcoholic beverages may help.

Further information

May Clinic. (2014). Testosterone therapy: Key to male vitality? Healthy Lifestyle, Sexual Health. http://www.mayoclinic.org/healthy-living/sexual-health/in-depth/testosterone-therapy/art-20045728

National Institutes of Health, National Library of Medicine. (2014). Low testosterone tutorial. MedlinePlus. http://www.nlm.nih.gov/medlineplus/tutorials/lowtestosterone/htm/index.htm