For men of a certain age who feel lethargic, lumpy and maybe a tad limp, it is -- they are convinced -- T time.
In record numbers, American guys are turning to testosterone boosters to repair their pep, revive their sex drive, even erase their erectile issues. Annual sales of the prescription hormone have more than doubled since 2008, according to IMS Health, Inc., reaching $1.6 billion last year, en route to $5 billion by 2017, some analysts predict. And that doesn’t include testosterone supplements purchased over the counter or via the mail.
“We are seeing a very dramatic increase,” in men taking testosterone supplements and drugs, said Dr. Edmund Sabanegh, chair of the urology department at the Cleveland Clinic.
But the quick medical fix many seek for nagging male ills that come as naturally as receding hairlines also can bring on side effects including blood clots and infertility.
After age 30, testosterone levels dip about 1 percent each year. As internal stores of that hormone decline, men can experience a loss of muscle mass and strength, depression, lethargy and a waning interest in sex.
“The symptoms of low testosterone are kind of what many of us feel when we get older: maybe a little decrease in energy, a little erectile problem, a little drop in libido,” Sabanegh said. “Often, those are normal” for men in their 40s, 50s or older.
“And when that’s the situation, we just talk about making lifestyle changes, taking a few pounds off, getting on a regular exercise program, improving their diets,” Sabanegh added. “Those sorts of things can, in many patients, give them the kind of effect they were hoping for in the testosterone.”
For Sabanegh to place a patient on testosterone therapy, he said the man must exhibit the saggy-draggy clinical symptoms of low testosterone. Then, a lab test must confirm that the patient’s hormone level has slumped to an abnormal number. Although that line varies by individual, typically Low T means the count is less than 300 nanograms per deciliter.
While supplements can boost a man's energy and get his sexual enthusiasm back to normal, the problem is many men's testosterone use isn't monitored by a physician. Sabanegh has treated patients who show up suffering the side effects from hormone dosing. “On occasion,” he said, “…I have seen acne and elevated red blood cell counts” – which can cause blood clots. Simply stopping the medication will end those side effects.
One testosterone user who has not suffered any such symptoms is Dan Nobel, 61, a nutrition store owner in St. Louis. In fact, the only changes he has noticed, he said, are a happier lifestyle and strength improvements.
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A competitive bodybuilder, Nobel routinely scrutinizes his meals and his weight, 165 pounds. Last year, he decided to try his first over-the-counter testosterone supplement, 2TX, simply because he had reached age 60. (He’s never had his testosterone count checked by a physician, he said.)
“At the gym, when I did a squat (press) or a bench press, I went up 10 pounds. My libido seemed better too. And that was just after like two days of being on it,” Nobel said. “I thought, wow, this does seem to make a difference.”
Recently, at a local bodybuilding competition, Nobel won his division – men aged 60 to 69.
Meanwhile, anti-aging clinics catering to men (and women) in that same age bracket have sprung up across the nation, with many promoting testosterone drugs to their male clients.
At Vitality Logix, a wellness center specializing in aging in New York City, founder Joshua Gizersky said the key to "successful therapy" is diagnosing the reason testosterone is low "and judiciously replacing (it) to levels consistent with a 25-year-old male."
“Guys in their early 20s are thought to have some of the highest testosterone levels in their lifetime and commonly surpass (a count of) 800,” said Gizersky, a doctor of osteopathic medicine. Consequently, “this age is chosen as the ideal target, especially when using testosterone for age-management reasons in older men.”
That can mean prescribing enough extra testosterone to propel a man's count from about 250 to twice or as much as four times that amount, Gizersky said.
The range for “normal” testosterone in a healthy male is 300 to 1,200 nanograms per deciliter, according to the National Institutes of Health.
In addition, users of oral (typically, over-the-counter) testosterone supplements -- like the one Nobel has taken -- should be wary, both doctors warned. Some over-the-counter forms of testosterone taken orally are known to cause liver damage when the supplements are metabolized, Sabanegh said.
"Most of the people working at GNCs and Vitamin Shoppes have very little education on this subject matter," Gizersky said. "Many are high school kids or college students without any concept of what they are selling and certainly no knowledge of the human physiology involved, nor the production methods used in these products -- which makes for a very dangerous situation."
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