The damaging effects of low testosterone in men


In July 2014, Time magazine ran a cover story titled: ’Manopause?! Aging, insecurity and the $2 billion testosterone industry’. It noted that prescriptions for testosterone – commonly known as the ‘male’ hormone, though in truth both men and women produce testosterone – had nearly trebled between 2007 and 2013, generating $2.4 billion in the US alone. 

Why were testosterone injections so popular? The short answer is that they can help men restore the punchiness in life – energy, athleticism, immune system and sex drive. Admittedly that all sounds great, but three questions spring to mind: 

  1. Are testosterone levels dropping in men?
  2. Is a low testosterone level damaging to men’s health?
  3. Is it healthy to replenish our testosterone levels in this way, or can it be damaging?

The short answers are, in order: Yes. Yes. It depends. Let’s dig a little deeper to find out more.

Dwindling testicular functioning in men

The testes of men produce two elements key to life: testosterone and sperm. The levels of both have been studied over the years, with disturbing results:

  • Over the past 70 years, multiple studies have looked at the male sperm count.  A recent summary of these studies showed that although the average sperm count in 1960 was nearly 100 million per millilitre, it had plummeted by 2017 to 49 million. As you might expect, that hurts a couple’s ability to have children. Some of my patients struggle with fertility, and it’s not uncommon for a man to have a sperm count below 20 million per millilitre.
  • A large US survey called the ‘Massachusetts Male Aging Study’ looked at the testosterone levels of men of different ages, and found that the level at every age had declined decade by decade since the 1980s.

The fact is that, as we age, our testosterone level can as much as halve, leading to weaker muscles and a diminished sex drive. However, if the average testosterone level is dwindling on top of this natural decline associated with ageing, what does that mean for male health?

The damaging effects of low testosterone in men

Since the start of the millennium, a number of studies have shown that low testosterone is associated with a worsening risk of obesity, dementia, heart attacks, diabetes, strokes and early death from a range of diseases.

In other words, there is growing evidence that a low testosterone level can worsen a man’s chances of dying from one of the modern chronic illnesses and is therefore associated with dying younger. 

All of which brings us back to the Time magazine article, and whether taking testosterone supplements will turn us into ageing heroes, improve our health and reduce the chance that we might die prematurely from these diseases?

Sensible testosterone replacement restores health

Like much else in life, balance is key: a range of studies shows that replenishing our testosterone level as we age will help us to lose fatty weight, improve our sugar and cholesterol levels and reduce our chances of having a heart attack. It even improves the mental functioning of dementia patients.

But that is not to say that we males should grab this powerful hormone off the shelf and start daily injections. Far from it. Because although we know low levels of testosterone harm our health, we also know that high levels are damaging. 

That is why in my clinic the first thing we do is measure the patient’s testosterone level, along with the levels of a number of other hormones. (Why other hormones? Because hormones react in complex ways, and an imbalance in others can provide clues as to any underlying problems.) 

Only once we know our starting point can we hope to give professional advice on what types of testosterone injections are safe, how much one should take (or even whether one should steer clear of it altogether) and for how long. 

For both men and women, hormone balancing is a complex topic, and I trust that it’s clear that there is far more to helping men with their testosterone than simply giving a testosterone jab and hoping for health – despite what the Time magazine article implies that some are clearly doing.

Readers who are interested in learning more can turn to the Men’s Health chapter in my book Younger for Longer: How You Can Slow the Ageing Process and Stay Healthy for Life. It was published in 2018 the UK by Robinson and in South Africa by Jonathan Ball, and was hailed by the UK’s Sunday Post as ‘revelatory and accessible’. It is available on Amazon or get in touch with IHA.

[1] Levine H, Et al. Temporal trends in sperm count: a systematic review and meta-regression analysis.’ Hum Reproductive Update. 2017: 1-14.
[2] Travison TG, Et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab. 2007;92:196-202.
[3] Liefke E, Et al. Age-related changes of serum sex-hormones, insulin-like growth factor-1 and SHBG levels in men: cross-sectional data from a healthy male cohort. Clin Endocrinol. 2000: 53: 689-95.
[4] Stellato RK et al. Testosterone, SHBG and the development of type-2 diabetes in middle-aged men: prospective results from the Massachusetts Male Ageing Study. Diabetes Care: 2000: 23: 490-4.
[5] Selvin E Et al. Androgens and diabetes in men: results from the third National Health and Nutrition Examination Survey (NAHANES 111). Diabetes Care. 2007: 30: 234-8.
[6] Khaw KT Et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease and cancer in men. EPIC-Norfolk prospective population study. Circulation. 2007: 116: 2694-701.
[7] Hackett G Et al. Testosterone replacement therapy improves metabolic parameters in hypogonadal men with type-2 diabetes but not in men with coexisting depression: the BLAST study. J Sex Med. 2014. 11: 840-56.
[8] Dhinsa S Et al. Insulin resistance and inflammation in hypogonadotropic hypogonadism and their reduction after testosterone replacement in men with Type 2 Diabetes. Diabetes Care. 2016: 39: 82-91.



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