Testosterone and Aging

Aging, Aging Bodily Changes

Testosterone and Aging

Testosterone is the prototypical male hormone. It’s what puts hair on your chest and muscles on your frame during puberty. Put simply, testosterone is what makes a man a man.

The BAD News

Testosterone Levels as You AgeAs men age, total testosterone levels decline. Even worse, free testosterone (testosterone not bound in the blood) levels decline more rapidly than total testosterone.1-3 The official term for this decline in testosterone levels is late onset hypogonadism (LOH), but it’s more commonly referred to as low testosterone or, simply, “Low T”.

What problems result from low testosterone?

Testosterone Fat Mass and Muscle MassLow testosterone levels have been correlated with INCREASED abdominal fat and DECREASED muscle mass.4-8 Even worse, low testosterone levels are associated with and increased risk of cardiovascular disease and metabolic problems, such as diabetes. Low testosterone can also cause erectile dysfunction, depression, and mood changes.9

The GOOD News

Fortunately, TRT for men with low testosterone can improve many symptoms associated with low testosterone including sexual function,10 muscle mass and strength,11 and bone density,12 and may also benefit other critical functions including metabolic,13,14 cardiovascular,15 and cognitive16 function.

Does Every Older Man Have Low Testosterone?

No. Many men have normal testosterone levels throughout their lives and will never need treatment. In fact, among men over the age of 60, only about 1 in 5 men have a total testosterone level that falls below the normal range. However, many men, even those in the lower end of the normal range, still suffer from problems associated with low testosterone and could potentially benefit from testosterone replacement therapy.

The normal range for testosterone is between 350 ng/mL and 900 ng/mL.  This means that one man can have nearly 3 times more total testosterone than another man, but both can still be normal.  The change in testosterone can be just as important as the actual clinical value for the presentation of symptoms.  However, low testosterone is strictly defined as having less than 350 ng/mL.  This means that many men fall within the normal range but still suffer from signs and symptoms of low testosterone.  Unfortunately, it has not become clear whether for aging men new criteria for testosterone deficiency should be established.

Will TRT Cure All of the Ailments Associated with Aging?  Will TRT Reverse Aging?

Unfortunately, the answer to both of these questions is a resounding NO! Testosterone replacement therapy will NOT make up for poor diet, lack of exercise, and a generally unhealthy lifestyle. It is not a magic bullet. It will not reverse aging, despite what some would like you to believe.

For those with low testosterone, combining proper diet, exercise, and good sleep with testosterone replacement therapy can make you both stronger and leaner and feel better. Check out the links below to learn more about signs of low testosterone, benefits and risks of TRT, currently available formulations of testosterone, follow-up guidelines, and more:

1. Moffat SD, Zonderman AB, Metter EJ, Blackman MR, Harman SM, Resnick SM. Longitudinal assessment of serum free testosterone concentration predicts memory performance and cognitive status in elderly men. J Clin Endocrinol Metab. Nov 2002; 87 (11): 5001-5007.
2. Morley JE, Kaiser FE, Perry HM, et al. Longitudinal changes in testosterone, luteinizing hormone, and follicle-stimulating hormone in healthy older men. Metabolism. Apr 1997 ;46 (4): 410-413.
3. Araujo AB, O’Donnell AB, Brambilla DJ, et al. Prevalence and incidence of androgen deficiency in middle-aged and older men: estimates from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. Dec 2004; 89 (12): 5920-5926.
4. Kaufman JM, Vermeulen A. The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev. Oct 2005; 26 (6): 833-876.
5. Makhsida N, Shah J, Yan G, Fisch H, Shabsigh R. Hypogonadism and metabolic syndrome: implications for testosterone therapy. J Urol. Sep 2005; 174 (3): 827-834.
6. Kapoor D, Malkin CJ, Channer KS, Jones TH. Androgens, insulin resistance and vascular disease in men. Clin Endocrinol (Oxf). Sep 2005; 63 (3): 239-250.
7. Liu PY, Death AK, Handelsman DJ. Androgens and cardiovascular disease. Endocr Rev. Jun 2003; 24 (3): 313-340.
8. Pitteloud N, Hardin M, Dwyer AA, et al. Increasing insulin resistance is associated with a decrease in Leydig cell testosterone secretion in men. J Clin Endocrinol Metab. May 2005; 90 (5): 2636-2641.
9. Miner MM. Low Testosterone Medscape CME Expert Column Series. Issue 3: Delivering Safe and Effective Testosterone Replacement Therapy. Medscape Education. 2011.
10. Rhoden EL, Morgentaler A. Symptomatic response rates to testosterone therapy and the likelihood of completing 12 months of therapy in clinical practice. J Sex Med. Jan 2010; 7 (1 Pt 1): 277-283.
11. Page ST, Amory JK, Bowman FD, et al. Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T. J Clin Endocrinol Metab. Mar 2005; 90 (3): 1502-1510.
12. Isidori AM, Giannetta E, Greco EA, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf). Sep 2005; 63 (3): 280-293.
13. Heufelder AE, Saad F, Bunck MC, Gooren L. Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and improves glycemic control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone. J Androl. 2009 Nov-Dec 2009; 30 (6): 726-733.
14. Kapoor D, Goodwin E, Channer KS, Jones TH. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol. Jun 2006; 154 (6): 899-906.
15. Chahla EJ, Hayek ME, Morley JE. Testosterone replacement therapy and cardiovascular risk factors modification. Aging Male. Jun 2011; 14 (2): 83-90.
16. Zitzmann M. Testosterone and the brain. Aging Male. Dec 2006; 9 (4): 195-199.

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