Lowered energy levels, heart problems, an inability to exercise, and depression in men can often be traced back to one single source—testosterone; yet for various reasons, over a third of men go untreated.
It’s a common misconception that testosterone therapies are used merely to boost sex drive and build excessive muscles, said Dr. David Shusterman, the chief physician at New York Urology. On top of that, most patients don’t even realize when they have low testosterone after a medical checkup because of the way lab reports are written.
Another misconception is that the problem only affects older men.
“A lot of times, people don’t check their testosterone. They can be very young guys walking around with a lot of the symptoms,” Shusterman said. It can occur in men as early as their 20s.
“Some people realize it because they have a low sex drive, and they talk to doctors and then get to see me—but many people just live with it, don’t talk about it, don’t say anything,” Shusterman said.
Testosterone therapy typically includes three types of treatments: pellets, salves, or pills.
“There are two broad ways to treat low testosterone. One is giving back testosterone itself,” Shusterman said. “Another way is to give a stimulating hormone that stimulates the body to produce more testosterone.”
For men who plan to have children, Shusterman recommends treatment to stimulate the body’s natural production, which is typically done with pills.
“Not only does it increase the testosterone level, but it will increase their fertility level because low testosterone can cause low fertility as well,” Shusterman said.
The stimulating hormone causes the body to produce more testosterone, which doctors divide into two categories: free testosterone and testosterone-binding hormones, which account for the bulk of the testosterone produced but actually have little effect on the body.
Free testosterone is what the body needs to balance everything from mood to metabolism. Treatments that give back testosterone only increase the free testosterone.
For men not concerned with fertility, Shusterman recommends a subcutaneous pellet.
“Once you put it in underneath the skin, they dissolve over four months,” Shusterman said. “You set it and forget it. … It’s very easy. Three times a year you come to a doctor, and you’re basically at a normal testosterone state.”
The pellet treatment typically costs half has much as pills or salves, which oftentimes patients don’t keep up with because they need to take or reapply them so frequently. Salves, like creams or jellies, can also rub off the skin onto clothes or other people, and can get messy
Unlike estrogen, which has complications with malignancies, testosterone does not cause prostate cancer, contrary to belief, Shusterman said.
“If someone has prostate cancer, their PSA (Prostate Specific Antigen) level is artificially high,” Shusterman said. When testosterone is raised, PSA levels also rise, which can cause already present prostate cancer to grow, making it detectable. Shusterman said that they always monitor PSA levels at New York Urology for this reason.
“It’s safe to use in almost all situations; it’s even safe to use in people who’ve had prostate cancer but have been treated for it,” he said.
Oftentimes a patient will get his results back from the lab and see a testosterone level lower than 300 but still labeled normal by the lab, despite that being half of what their levels should be.
Lab numbers vary, but some disregard the patients’ age and use a range that shows the average testosterone level for men over 80. Other charts might disregard sex and show a minimum figure for a normal level of testosterone for females, meaning no male checkup would come out as abnormal despite being too low for their age.
Low testosterone also slows your metabolism.
“The main thing it does is it creates a low level of basal metabolic activity,” Shusterman said. Your basal metabolic rate (BMR) is the minimum calorie requirement needed to sustain your body, and when it’s unbalanced, it makes it hard for people to exercise as well.
“Their BMR is low artificially because their testosterone level is low,” Shusterman said. The patient may feel sluggish but also find himself unable to exercise and see no results when he does.
Once patients start their treatments, Shusterman said he’s had people see results from within a day to six months.
Along with the testosterone treatment, Shusterman also guides patients to make diet and lifestyle changes that support their health.
“And I don’t just give people testosterone treatment, toss them out there, and hope they do the best. I give them an exercise regiment. I tell them what foods to eat. I tell them how to maximize their newfound BMR and improved exercise capacity,” he said.
“There’s a lot of unnecessary issues and suffering that goes on when the levels [of testosterone] aren’t adequately checked, monitored, and regulated,” Shusterman said.
He adds this is largely because it’s not an area most doctors or patients are interested in to begin with. It tends to be out of their field, and when symptoms such as low energy or low sex drive show up, doctors prescribe something for that one symptom rather than suspecting low testosterone.
“Don’t let people give you some medication and hope it goes away,” Shusterman said. “This is an important thing to check, and people aren’t checking it. They’re just giving people Viagra, Cialis.” But if you treat the root cause, you don’t need a variety of medications, he said, and testosterone replacement therapy is almost always covered by insurance.
“Once people start checking it and people have good response, people appreciate it,” he said. Many of his patients have returned to tell him how much better they feel.
“I’ve seen many patients just come in and they say they feel better,” Shusterman said.
Testosterone replacement therapy can also reduce the chance of cardiovascular disease, according to a study published recently by the Boston University School of Medicine.
Thus the consequences of not treating testosterone deficiencies are serious, Shusterman takes the time to educate his patients and fellow doctors. Through word of mouth, more men are getting their testosterone levels checked in the clinic, he said, and it’s becoming an easier issue to talk about.
New York Urology (Manhattan location)
201 E. 65th St.
New York, NY 10065