The Dose25:07What might testosterone replacement therapy mean for me?
When people go online in search of solutions for symptoms like fatigue, mood changes and low libido, they often find podcasts, Reddit forums and social media posts that are quick to blame low testosterone and suggest supplements as the answer.
Experts like OB/GYN and hormone specialist Dr. George Arnold note that there can be a variety of underlying causes for such symptoms, and say the hype around testosterone on the internet may not stand up to actual medical scrutiny.
Roughly two per cent of men have low testosterone according to some estimates, though numbers fluctuate with age.
A 2021 study in the Canadian Urological Association Journal suggests the prevalence of testosterone deficiency is estimated to be four to 12 per cent in men aged 50 to 59 years; nine to 23 per cent in men aged 60 to 69 years; and 28 to 49 per cent in men over 70 years old.
The prevalence of testosterone deficiency in women is lower. A 2019 study in the Journal of General Internal Medicine looking at U.S. women showed that four in 10,000 women were prescribed testosterone in 2017, suggesting fewer overall cases of testosterone deficiency than men.
Arnold and other experts caution against testosterone supplements that promise easy health and wellness fixes. They say that prescribed medication is the only effective way to boost hormone levels.
What is testosterone?
Testosterone is a natural hormone present in both males and females, commonly known for its role in the development of secondary sexual characteristics in males, such as deepening the voice, inducing body hair growth and changing the shape of the face and skeleton — among other changes.
It can also help with muscle health, sexual function and mood in both men and women.
“There is a huge difference between the amount of testosterone in a male and the amount that’s in a female, but ultimately it does the same thing,” said Arnold.
A simple blood test is capable of measuring the body’s testosterone levels. Testosterone in all forms is a controlled substance in Canada and is only available with a prescription.
These days, you don’t have to scroll too far to find influencers hyping up big muscles and masculine workouts. CBC’s Anya Zoledziowski examines steroid use among young men and uncovers a dark side to the growing pressure to be jacked.
On average, Arnold says testosterone levels peak around the age of 30 in both men and women, then begin to gradually decrease over time.
As testosterone levels decrease, both men and women can notice symptoms like fatigue and increased weight gain.
Diabetic patients with low testosterone can even have difficulty maintaining blood sugar control, according to Ottawa Hospital urologist Dr. Luke Witherspoon.
Women can experience a drop in testosterone levels during menopause, resulting in symptoms like hot flashes, increased sweating and poor sleep, according to Arnold.
The Australian Menopause Society says women’s testosterone levels during menopause are roughly one quarter of what they are at their peak.
Despite the stereotype of high testosterone levels being associated with a bulkier physique or increased virility, Witherspoon says a man with naturally higher levels of testosterone wouldn’t necessarily be visibly different from men with lower levels.
“He wouldn’t be more fertile, he would not necessarily recover from injury better,” said Witherspoon.
Research does suggest that testosterone can help men grow muscles, but not necessarily strengthen them.
Here and Now Toronto7:40Testosterone is being sold as a quick fix for low libido and gaining muscle, but does science back these claims?
There’s much talk about testosterone replacement therapy, in men. “T,” as it’s known, is all over the internet these days. It’s sold with the promise of gaining muscle, curing fatigue and increasing libido.Dr. Iris Gorfinkel is a family physician and a clinical researcher. She takes a look at “T”, and has some sobering scientific conclusions. She was on Here and Now.
Low testosterone not always to blame
Though many men — and some women — might assume they’re experiencing these symptoms because of low testosterone, Witherspoon says the hormone isn’t necessarily to blame.
He says that because of the general population’s understanding of testosterone, men who feel fatigued might reach the conclusion that it’s due to low testosterone “because that is a nice simple fix.”
Arnold recalls a male patient whose symptoms seemed to indicate low testosterone. A blood test confirmed that his levels were low, but also showed that he had low iron.
Once the patient’s iron levels were back up, Arnold says, “His energy was back, his sex drive was back. He didn’t need testosterone, he just needed his chronically low iron taken care of.”
Low vitamin D, low iron levels as well as thyroid problems, sleep apnea and other hormone conditions can also be responsible for the symptoms associated with low testosterone.
Physicians tend to be careful when prescribing testosterone, because there are risks for both men and women.
“A lot of [male] patients don’t realize that fertility will be stopped with testosterone replacement therapy,” said Dr. Premal Patel, a University of Manitoba urologist.
“It will shut off your pituitary axis and then it will stop sperm production.”
Some early studies have explored using testosterone gel during ovulation for women who had a poor ovarian response during in vitro fertilization (IVF) cycles. However, sources like the U.K.’s National Health Service caution against taking testosterone during pregnancy, warning it may affect the baby’s development.
Testosterone also thickens the blood, which Patel says might increase the risk of stroke and heart attacks, though he cautioned that more research is needed to determine the full extent of potential risk.
‘Save your money’ and avoid supplements
Arnold says the two most common ways to treat low testosterone in men is through an injection, or an oral medication called clomid that stimulates the body’s natural testosterone production.
A medication known as human chorionic gonadotropin (HCG) can also stimulate testosterone production.
“We’ll typically use that for a week over the course of every four weeks, and then the other three weeks we’ll add testosterone in,” said Arnold.
When non-binary photographer Laurence Philomène started taking testosterone, they documented the experience with daily self-portraits for two years. The result is a photo collection called Puberty that has been exhibited all over the world and featured in Teen Vogue and The New Yorker.
There are no testosterone therapies approved for women in Canada, but women can be prescribed a cream or oral dose through a compounding pharmacy, according to Arnold.
Improving diet, exercise and sleep can also naturally improve testosterone levels.
Experts say people are better served by avoiding supplements that claim to boost or contain testosterone. Arnold says they often contain unregulated ingredients or simply don’t contain any testosterone at all.
“Save your money,” he said.
