07/02/2013 04:33 pm ET Updated Sep 01, 2013

Testosterone the Man Maker?

Men aren't what they used to be.

Once upon a time, only women experienced menopause and became candidates for hormone replacement therapy.

We now have andropause, or male menopause. Male hormones are known as androgens, a word derived from Greek meaning man-maker. And yes, men are lining up for hormone replacement.

Has the American male developed hormone replacement envy?

Prescription sales of testosterone have skyrocketed. As recently as 1988, testosterone sales in the U.S. were well under 18 million dollars. By 2011 that number had jumped to 1.6 billion dollars. Between 1993 and 2002 testosterone prescriptions grew by 25-30 percent per year.

The only approved indication for the use of prescription testosterone is a relatively uncommon condition called hypogonadism. This clinical syndrome is defined by an inability to make normal amounts of testosterone and sperm due to diseases of the testes, pituitary or hypothalamus. Testosterone treatment has proven enormously beneficial and safe for this disorder. The same benefits and safety in otherwise healthy aging men remains unproven.

The prevalence of hypogonadism has not changed.

This means that a large population of American men with (and without) age-related decreases in testosterone is receiving testosterone therapy, an unapproved intervention.

Now let's get a couple of things straight:

Hypogonadism is completely different than an age-related decrease in testosterone production. And there is no male equivalent of menopause.

Testosterone levels peak in men's 20s and 30s and then gradually decline with age. Unlike menopause, there is no sudden drop in male hormone levels. In addition, the rate and extent to which testosterone levels decrease with age is quite variable.

Has the pharmaceutical industry created a false condition and cashed in on it?

No and yes.

No, the decrease in testosterone levels is real. And yes, they are cashing in on it.

Clinical studies indicate that testosterone levels were 20 percent higher in 1987 than in 2007, regardless of age. The average sperm count has also decreased significantly over the last century.


Are men just less hormonally manly than they used to be?

Well, on average, yes.

But I don't think the answer, for most us, is a good rubdown with testosterone jelly.

Let's look at what we see when we see low testosterone.

The odds of having low testosterone are 2.4 times higher in the obese, 2.1 times higher in those with diabetes, and 1.8 times higher in people with high blood pressure.

As we you know, these disorders have grown to epidemic proportions over the past several decades. Has a mysterious dip in testosterone levels caused the dramatic acceleration of these conditions?

I don't think so.

We have known for some time that men with excess body fat not only have low testosterone levels but also harbor abnormally high estrogen levels, a major female hormone. Fat cells convert testosterone to estrogen. In this sense, fat is literally emasculating.

Seventy percentof adults in the U.S. are overweight or obese. Nearly 80 percent of adult Americans do not get the minimal amount of exercise recommended. The gradual path to these numbers over recent decades helps explain the downward trend in testosterone levels over the same period.

So what can men do -- short of taking testosterone?

The following steps have proven effective in raising testosterone levels.

• Lose weight
• Be active and strength train
• Get at least 7-8 hours of sleep
• Manage your stress
• Make sure your zinc and vitamin-D levels are not low

I know. "Easy for you to say, Doc."

Start slow. Do something to achieve these things everyday, no matter how small. Give yourself plenty of time. Remember that you're doing a lot more than increasing your testosterone level in taking these steps. These things decrease your risk for diabetes, cardiovascular disease, high blood pressure and obesity.

Man up your lifestyle before you reach for the "man-in-a-can" solution.

For more by Paul Spector, M.D., click here.

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