Once upon a time, our understanding of the role that testosterone played in men’s (and women’s health) was restricted almost entirely to sexual differentiation, male sexual behavior, big muscles and aggression. Certainly, everyone is aware of the steroid doping scandals that have plagued professional and amateur sports for the last two decades. To the general public and to much of the medical profession, testosterone was dangerous (and in large amounts, it certainly can be). But now, the tides are changing and testosterone gels are being marketed aggressively to the average Joe who just wants to reclaim his masculinity. Combine the marketing for testosterone with Viagra and Cialis ads, and it becomes clear that male sexual functioning is all the rage these days. Hardly a day goes by that I don’t see an ad for one of the many testosterone replacement products.
Why is testosterone so popular?
It turns out that testosterone, like other steroid hormones, perform a complex set of functions related to health; ranging from cardiovascular and metabolic regulation, to cerebrovascular and neurotransmitter modulation. Despite the marketing (more testosterone equals better sex drive and a better physique), sex hormones are not just about sex or big muscles.
It turns out that low testosterone is associated with an increased risk of cardiovascular disease, increased insulin resistance and depressed mood. In vets, low testosterone is associated with an increased risk of PTSD, metabolic syndrome and mortality from any cause. While researchers and functional medical specialists have understood the importance of steroid hormones for years (all the way back to Hans Selye), this knowledge has been slow to transfer into mainstream clinical health; that is, until it could be commercialized into libido enhancer.
When testosterone concentrations wane as men age, the risk for many of the diseases of aging increase (cardiovascular disease, stroke, etc). Much like the hormone replacement therapy (HRT) prescribed for female menopause, pharmaceutical companies are hoping that testosterone replacement eases the symptoms of andropause (low libido, depression, weight gain) and reduces the risk for cardiovascular and other disease processes. Though it is too early to tell if testosterone replacement will follow the same over-marketing that HRT did. (HRT was first marketed to enhance libido and general health, then gradually became the panacea for all diseases of aging. The over-reach was not supported by science and subsequently was followed by billions in lawsuits. A gradual retraction of uses and re-positioning as simply a medication to be taken as briefly as possible to help with hot flashes is now marketed). What is clear, is that the role of hormones in health is becoming more mainstream. For that, we thank the gods of waning male virility.
For more on the role of testosterone in health:
Testosterone: What it Does and Doesn’t Do
Andropause: A British Perspective
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I tend to agree, especially regarding the use of bios vs synthetics. And as the research cited in the article indicates testosterone, and indeed other misaligned, misunderstood hormones, is not just for sex- although that is what is advertised. One has to be careful however, of mistaking the role of endogenous hormones in health and disease and the supplementation of synthetics. As with HRT, – equine estrogens- many still confuse those compounds with endogenous estradiol. HRT- the history of which is fascinating, if not a little frightening- the marketing began w/ sex and expanded outward, playing on the confusion between endo and exo/synthetic. I fear the same thing will happen with testosterone- it will become the panacea for everything.
In reference to the current recommendations for hormone replacement, one must remember that the current guidelines reflect the indications for synthetic hormones not bioidenticals. Properly prescribed bioidentical hormones, started at the appropriate time are quite valuble in the preventin of disease and maintenance of health. Bioidentical hormone replacement is safe if done properly and the patient follws a hormone healthy lifestyle.
It’s not about sex (though that is enhanced too). It is about health and longevity. Women should be told of all the problems they will face as a result of the loss of their hormones as well as the risk of using hormones. On balance, I would opt for bioidentical hormone optimization over the gradual, progressive ravages of the aging process.