Should I Take Testosterone for 'Low T'?

My doctor stops short of rolling his eyes when I ask to have my testosterone levels evaluated. But a jambalaya of microexpressions seems to suggest I’m certainly not the first of his patients to get unduly panicky about his testosterone, the primary male hormone slowly ebbing away. “This may not be covered by your insurance,” he says with a shrug. “That’s fine,” I say, resigning myself to incurring the cost of being just another schmo big pharma has fooled into asking his doctor about “Low T.”

In my imagination, testosterone is the ultimate performance-enhancing drug. Producing or being prenatally exposed to higher levels of testosterone has been associated with greater strength and muscle growth, a high libido, frequent erections, a more competitive nature, and comfort with risk. Physical signs that a guy is swimming in his own testosterone include: a generous amount of body and facial hair, broad shoulders, a wide face, a more pronounced brow, a deep voice and long ring fingers—which some studies have shown is linked to larger penis size; less body fat, and higher bone density.

I can claim a few of these attributes—most notably my habit of becoming a maniacal see-you-next-Tuesday when I find myself on the losing team in game of Cranium. But my rather high, sing-songy voice, hairless chest, and ability to borrow and convincingly wear my girlfriends' clothes would leave few thinking that my slender veins are coursing with C19H28O2.

And I’m more than okay with that. This enduring perception is likely why I’m never asked to attend—much less arrange—a bachelor party, back someone up in a street fight, or give my opinion about the big game.

But in the fall I started to notice that my never-big-but-always-baseball-hard biceps were decidedly more squishy when I flexed them. I resolved to do more curls in the gym, but while I was waiting to see those results, I started thinking about how the average ejaculations of my salad days had more volume, velocity, and range than my current emissions. Neither of these things have an especially significant effect on my life. But, combined with the awareness of low testosterone I’d acquired via osmosis, I had just cause to spend the next several minutes investigating whether my diminished vigor could be chalked up to it—and subsequently remedied.

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A google session revealed that along with mood changes, a loss of libido, diminished erections, the loss of body and facial hair, decreased bone mass, fatigue, and a slew of other things, soft muscles and less-than-ebullient ejaculations are absolutely associated with lower levels of testosterone. You may have already gotten ahead of me and noted that many of the symptoms I listed above sound a lot like what happens when men get older. Indeed, that’s broadly true. Lower testosterone and age are inextricably linked.

If you’ve ever known (or been) a male between the ages of 14 and 18, you won’t be surprised to know that this is when testosterone levels naturally peak. After the age of around 30, testosterone levels decline by about 1 percent per year. That this occurs at the same time as a drop off in brawling, frontin’, chain-wanking or giving a shit about the latest sequel in The Fast and The Furious franchise is likely no coincidence.

However, a study from 2007 showed something slightly more alarming: an age-independent, population-level decrease of testosterone in American men based on data collected between 1987 and 2004. Authors offered a less-than-elucidatory explanation of why this is may be happening, remarking that the juice sluice was “potentially attributable to birth cohort differences or to health or environmental effects not captured in observed data.”

Some studies have noted a connection between BPA and lower concentrations of testosterone while others have demonstrated a link with opioid use. But whatever the case, the ingredient that makes men and imbues them with traditionally masculine physical and behavioral traits seems to have been diminishing of late. As I have blood drawn, I take no comfort in these implications—that what I think is affecting me is affecting men in general.

According to a 2017 study published in The Journal of Clinical Endocrinology & Metabolism, the normal range of total testosterone in non-obese men between 19 and 39 years of age is between 264 and 916 nanograms per deciliter. In the week between having my blood drawn and getting the results, I spend a lot of my time half hoping that my total testosterone is at the low end of that range, low enough that my doctor suggests testosterone replacement therapy. I fantasize that a testosterone boost will have the same effect on me as a super mushroom has on Mario and I’ll become similarly endowed with incredible powers and abilities.

But the results infer that whatever is preventing me from becoming Super Grant, it’s decidedly not my testosterone levels. My total testosterone showed as 684 nanograms per deciliter while the amount of bioavailable or free testosterone is 16.3 picograms per milliliter. Biochemically speaking, I’m a Vin Diesel masquerading as a Michael Cera.

“Wait, how old are you?” asks Michael Reitano, when I ask him to interpret my results for me.

I tell him that I’m 41. “Well congratulations, you’re on the higher end of normal in terms of testosterone. Whatever complaints you have are going to be caused by something else.”

I’d sat down with Reitano earlier than week to discuss causes of erectile dysfunction in younger men, one of which was low testosterone levels. As the physician-in-chief at men’s health startup Roman, and with a background in sexual health, Reitano has a lot of knowledge to impart on the subject. But after glancing at my my lab work, he suggests that the consistent recent neck pain I’ve been experiencing could be related to my softer guns—“It could be a nerve impingement”—and he advises that I get that checked out. (I don’t press him on the jizz stuff because—as spectacular as they can be—dependably elephantine emissions aren’t particularly helpful.)

You won’t be surprised to learn that pharmaceutical companies have been quick to capitalize on guys’ dissatisfaction with their age-related “T” decrease by offering exogenous, vigor-restoring top-up testosterone in patch, injection, or gel form. The “is it low-T?” message certainly burrowed into the collective consciousness. A study published last year found that each exposure to testosterone advertising yielded a monthly 0.6 percent increase in testing, and a monthly 0.7 percent rise in prescriptions in the US.

Whether they presented with low concentrations of testosterone or not, for a large number of men who were written a script, testosterone replacement therapy (TRT) has done what they hoped it would to do, and in short order. Research from 2009 postulated that TRT upped self-confidence, sexual thoughts, fantasies, morning erections, total erections, ejaculations, and satisfaction with sex life over the course of a few weeks before plateauing, while reports of depression and fatigue simultaneously decreased. Interestingly, the study found no change in aggression—a trait that testosterone is commonly used to allude to.

The makers of TRT, market leader AndroGel, and other similar companies have been the ones coaxing men to ask their doctor about their testosterone, and they’ve been making mad money in the process, reporting sales of $675 million in 2016. Thing is, they might have to give a sizable chunk of that money back.

AndroGel’s makers, AbbVie, are defendants in thousands of lawsuits claiming that the risks of testosterone replacement were misrepresented by the company and that AndroGel causes heart attacks, strokes, and other injuries. To put it another way, they allege that the masculinity they were prescribed was literally toxic.

Some studies back the plaintiffs’ claims, while others seem to be in direct opposition to them. Regardless, the first two lawsuits ordered AbbVie to pay $150 million and $140 million respectively. In light of my results, the TRT is no longer appealing to me. In fact, if I’m still steeping in my own supply by the time I’m 70, I could be at a disadvantage. According to one Australian study, high T in old age may put me at a higher risk of developing prostate cancer.

Had my testosterone levels been on the low end of the scale, studies suggest I could significantly and naturally fluff them up by losing excess body fat, getting a solid eight hours of sleep per night, exercising—particularly resistance training—daily and cutting out booze. Y’know, the usual boring things you do that by and large make everything better.

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