Must be “Low T,” right?
Low T is a global problem of epic proportions. In fact, UK researchers are reporting that testosterone prescribing has reached epidemic proportions, with an increase in prescriptions by almost 90% between the years 2001 and 2010. Moreover, the majority of these prescriptions have not been for an established hypogonadism (a decline in the functional ability of the testes to produce ample amounts of testosterone. This can lead to erectile dysfunction, low libido and a low sex drive. Aside from sexual dysfunction, hypogonadism can also cause depression, lethargy and fatigue. And yet, the most recent statistics from the Urology Care Foundation suggest that low T is a problem mostly affecting men 60 and above. In the UK study, only 6.3% of men had definite hypogonadism. So, what gives?
A few years ago, the pharmaceutical industry jumped on the male menopause wagon and the current campaign is a doozie. The condition? Low T, which is better known as low testosterone, andropause or the commonly used misnomer, “male menopause.” In fact, you can take a simple quiz to learn if you have Low T and if you need to speak to your doctor.
I’ve written about male menopause and have also directed readers to data that shows that it may not be all that it’s cracked up to be. Is it irritable male syndrome? Or is it another marketing tool to sell drugs to unsuspecting men who are aging and losing their virility?
Truly, if you are feeling like a shadow of your former self, there may be other things at play than testosterone. You might want to speak to your healthcare practitioner before jumping on the Low T wagon. Too much testosterone can lead to heart disease and negatively affect the prostate gland.
The medical community remains unconvinced about the condition and the need to treat it. In fact, that might be why, in 2011, University of Pennsylvania researchers started putting it to the test with the T Trial, which may solve this question once and for all.Read More
Yes, I am taking poetic license with the Japanese term “Hara-Kiri” which literally means to cut or slice the stomach. This phrase has been hijacked by slangers who refer to it as ‘hari kari,’ to off oneself or commit suicide.
I propose that using testosterone in hopes of improving sexual desire is a great way to cut off one’s wellbeing and sense of self Chi, leaving hairs on the chinny chin chin and other undesirable locations.
Hairy kiri? You bet!
Back in 2008, I wrote about Intrinsa, a testosterone patch that was tested in a study of 841 postmenopausal not currently on hormone replacement therapy to test its effects on sexual desire after about a half a year’s use. The results, which were published in the New England Journal of Medicine, showed that compared to a dummy patch, using low or high dose Intrinsa was associated with significant increases in sexual desire and a decline in sexual distress. Overall, the higher dose patch led to modest improvements in sexual function. In other words, wearing a patch was significantly better than using nothing at all but not life-shattering in terms of improving sexual function. However, the caveat was unwanted hair growth, which occurred in about a third of women using the higher dose patch and in about 23% of women using the lower dose.
Once I delved further into androgens and women, I learned that while it has been suggested that local circulating levels of androgens are associated with low sexual desire and sexual dysfunction, the data are contradictory. Moreover, in a fairly recent scientific review, researchers say that no single androgen predicts which women will have sexual dysfunction, making it even harder to address, right? What’s more, they also note that laboratory studies have only limited value and aren’t routinely recommended.
Looking more closely at different formulations of androgens like testosterone, e.g. patches, oral tablets, implants and injections, experts have found that the major side effects are unwanted hair growth and acne. Both are related to dose and how long treatment lasts, and disappear once treatment is stopped. And while rates of hair growth are definitely lower for patches in general (as few as 7% to as high as 23%), as many as 36% of women who use oral testosterone have unwanted hair growth. Among those receiving implants, pellets or injections the number is also high: 20%.
Let’s face it; the trouble is testosterone is that it may only address a miniscule amount of factors affecting a woman’s libido and in literally leave a trail in its place. Don’t know about you but I think it’s a hairy kiri proposition. A few more notches on the desire scale and a few more hairs in your chin, on your chest and lord knows where else.
Committing hairy kiri ain’t for sissies; that’s for sure!
Female sexual disorder, also known as hypoactive sexual desire disorder (HSDD, i.e. lack of sexual desire) is big business and the race for the gold ring continues. While the FDA effectively put a halt to the antidepressant flibanseran only months ago, testosterone therapy continues to drive the march towards finding a cure for a low libido. The question remains, however, is this a good or bad strategy? And how about risks and benefits of adjunctive testosterone? Is it safe?
HSDD is a disorder that robs a woman of her libido and sexual desire. It is believed to affect up to 36% of women between the ages of 20 and 70, although slightly higher numbers of women with some degree of lowered sexual desire have been reported. Especially affected are women who have had their ovaries removed and have entered menopause as a result; these women in particular, have low testosterone levels. Notably, however, not all women who experience diminished sexual desire have low testosterone levels and the cause of HSDD is unknown. In addition to physical causes, relationship and interpersonal/psychological issues are also believed to play a role, making the condition even more difficult to treat. And while testosterone may be helpful for boosting libido, it has also been linked to side effects that include acne, excessive hair loss or growth, hoarseness, weight gain, insomnia, voice deepening and migraines. More importantly, use of testosterone has also been shown to increase cholesterol levels in some women, thereby raising the risk for heart disease.
According to research, the HSDD market ranges from $2 to $5 billion. Even more troubling is the fact that in 2009 alone, physicians wrote more than 4 million prescriptions for testosterone to treat HSDD even though it’s not approved as a therapeutic strategy.
LibiGel® is a topical testosterone gel that is applied to the upper arm. Thus far, it has been shown in short-term, 3 month clinical trials, to significantly increase the number of ”sexually satisfying” events by as much as 238% without serious side effects. Since these early trials, the company has been studying over 2,000 postmenopausal women over the age of 50 with an elevated risk for heart disease to observe how well the gel does over the long-term (i.e. 3 years). Thus far, the manufacturer BioSante reports that the rates of reported cardiovascular events and breast cancer are very low and plans to present interim data later this week at this year’s North American Menopause Society Meeting.
Is LibiGel going to liberate sexually dysfunctional women? And what about the other factors that affect desire, such as relationship status, self-esteem, stress and anxiety? Should we be concerned that physicians already prescribe testosterone ‘off-label’ for millions of women and that the company actually reports that over 90% of women using testosterone unapproved for this use would switch to LibiGel once it’s approved?
I am not quite sure if this is an example of irresponsible medicine or an untapped need. I would like to believe that LibiGel might be effective for certain women who have been forced into menopause due to physical conditions. On the other hand, doesn’t the medical treatment of HSDD ignore the obvious: that there are behavioral, social and environmental factors at play that testosterone therapy won’t and can’t address?
What do you think? Is this a bubble to be burst or the “re-desire” revolution? Only time will tell.Read More
In fact, in a newly published study in the online edition of esteemed New England Journal of Medicine, researchers show that low testosterone is a very rare condition, affecting only 2% of elderly men, most of whom have poor health and are obese.
Kind puts a an axe on the whole “shadow of one’s former self,’ eh?
In the study, researchers surveyed over 3,300 men between the ages of 40 and 79 (mean age, 59.7 years in order to collect information on general, sexual, physical and psychological health. They also measured blood samples daily for testosterone, and then divided the groups so that they could be compared.
In the entire pool, only 32 men were found to have severe low testosterone that could not be caused by any physical problem. What’s more, the researchers learned that many symptoms of what is considered classic male menopause were not actually associated with decreased testosterone levels, including loss of energy, physical ability, fatigue and depression) highlighting that what has been largely touted as “male menopause” is simply non-specific symptoms of aging.
The researchers concluded that only three symptoms were actually associated with male menopause, i.e. decreased frequency of morning erections, decreased sex drives (i.e. sexual thoughts) and erectile dysfunction, and that these symptoms, in concert with very low testosterone levels, had to be present in order to devise a true diagnosis of male menopause.
This means that male menopause, low T, whatever you call it, is overhyped, overdiagnosed and simply does not affect an overwhelming majority of men who are being unwittingly prescribed testosterone therapy when they don’t need it.
Men – please, speak with your doctor before starting testosterone to boost your sex drive. The researchers say that “testosterone may only be useful in a relatively small number of cases.”
Think you’ve got ’Low T/ male menopause?’ It may not be your problem after all.
Want more? Reuters Health also has a piece on this study.Read More
That age old battle of the bulge just got more challenging.. Researchers are saying that middle-aged women who store fat around their mid section are twice as likely as their peers to develop dementia in old age. Yikes! More reason than ever to lose that belly fat, right?
Starting in 1960, researchers looked healthy and lifestyle risk factors in 1,462 women and then at various intervals for 32 years. They found that women who were broader around the waist than the hips by the time they reached middle-aged more than twice the odds of developing dementia if they lived beyond 70 years. However, a higher body-mass index did not infer a similar risk.
Whether it’s associated with aging, testosterone or declining physical activity, weight gain around the midsection has been linked with the metabolic syndrome, which increases your risk for heart attack and stroke.
So, we’re left with a choice – heart attack, stroke or losing our minds….Or, better yet, move your body. Exercise, start eating healthier and being more mindful of what’s going in and what you are putting out. Granted, we may not be able to fight the inevitable but we can at least try to stave it off or control it as much as possible. The bulge around the middle is the hardest area to attack. But it’s not impossible.
I’d love to get some fitness experts to weigh in on this. Anyone?Read More