Men Who “Want Their Life Back”

By Ken Garneau PA-C

As men age, decreasing amounts of hormones can rob them of focus, drive and motivation. What is a “hormone?” A hormone is a chemical substance produced in the body that controls and regulates the activity of certain cells and organs. Essentially, hormones are required for every activity in life, and are directly responsible for the quality of living. Think of hormones as either tuning up bodily systems — or de-tuning them.

When hormones are “out of tune,” medical providers may say someone has a “hormone deficiency.” Hormone deficiency can be caused by a number of things: Chronic illness, disease, aging, certain kinds of tumors, trauma, infection, inflammation, decreased blood supply, autoimmune disorders, and some types of medications to mention a few. One hormone that is directly related to how human males feel and perform is called Testosterone.

Testosterone is a naturally occurring hormone found in all humans and animals – both female and male. Testosterone belongs to the androgen group of hormones, meaning it is a part of hormones called sex hormones. Sex hormones assist with sexual development and growth in children, and vitality and drive in adults. Testosterone is primarily produced in the testes of men and ovaries in women, although a small percentage is produced by the adrenal glands.

In adult males, testosterone deficiency is called hypogonadism. Hypogonadism occurs when there are sub-optimal levels of testosterone circulating in the blood. This lack of testosterone (sometimes called “Low T”) produces symptoms of low testosterone such as:

• Fatigue (no energy)
• Decreased muscle mass
• Decreased motivation/drive
• Decreased mental clarity
• Increased body fat
• Decrease in bone strength
• Depressed mood
• Decreased libido
• Erectile dysfunction

Not all men have “Low T,” but those that do may experience one or more of these symptoms on a regular basis as they get older. Normally, testosterone levels in men peak in their 20’s, and decrease approximately 1-2% each year. However, the decline experienced by those with chronic illness (such as Type II diabetes, obesity, chronic pain, inflammation, etc.) may progress at a much greater rate. There are a number of diseases and chronic conditions that may play a role in impacting testosterone levels. Untreated, low testosterone can be life threatening. Medical research has shown that untreated low testosterone is associated with increased incidents of negative effects such as:

Condition:	Untreated Low Testosterone Is Associated With:
Diabetes or glycemic control issues (hypoglycemia)	Increased insulin resistance, blood glucose levels, HbA1C, and higher incidence of diabetes
Problems with inflammation	Increased harmful liver enzymes, CRP and Cytokines
Lipids (high cholesterol, hyperlipidemia)	Increases in total cholesterol, LDL, and triglycerides
Body composition (muscle and fat)	Reduction in overall muscle mass, increased total body fat
Bone conditions	Decrease in bone mineral density
Cardiovascular problems	Increased blood pressure, intima media thickening, increased incidence of coronary artery disease
Sexual dysfunction	Decreased libido, impaired ejaculatory function, and increased erectile dysfunction
Quality of life issues	Decreased cognition and motivation, depression, overall lack of energy

Diagnosing and treating low testosterone involves taking a blood test to measure levels. Some medical provideres focus only on “total serum testosterone levels” to determine if a person has low testosterone. However, like any hormone, there are certain “receptors” in the body that allow the body to either use or reject testosterone (through a process called “binding.”) Some men may experience normal “total testosterone levels,” but still have symptoms. When this occurs, to obtain an accurate diagnosis, the provider should measure “free testosterone,” which is a measure of the usable amount of testosterone in the blood.

As a personal example, a few years ago, I was constantly fatigued. I am a medical provider and knew the symptoms of low testosterone. I asked my PCP to run my testosterone levels. The labs came back and the number fell within the “normal” reference range for total testosterone. However, when my “free testosterone” was measured, I was low.

Some providers consider “normal” testosterone to be between 350 ng/dl – 1000ng/dl. However, if a provider solely focuses on “total testosterone,” many men would never enjoy the vitality and life style possible with normal hormone levels. Because of how the body works, free testosterone is what drives the treatment and benefits of therapy.

Finally, some feel that age dictates the need for testosterone replacement. However, everyone is different, and individuals have different experiences, body composition, health history, and binding factors within their circulatory system. Earlier this year I treated a male patient who had total testosterone of 500 ng/dl, but was experiencing Low T symptoms. When we measured his free testosterone (the usable testosterone in his blood), he was low: About 7.5ng/dl. Had we not gone the extra step, this young man would still be suffering today.

Hormone replacement medicine is making a huge impact on the lives of men who suffer from low testosterone. Approximately 13 million men in the US are estimated to have untreated, low testosterone. As a medical provider, I would encourage any man, 26 years or above who is suffering from the symptoms outlined in this editorial, to contact an experienced, trusted physician for testing.

About the Author: Ken Garneau is a licensed physician assistant in California and is the Center Director for the American Male Medical Center in Irvine, California (Phone: (888) 434-5338. Mr. Garneau practices with physicians who diagnose and treat low testosterone and erectile dysfunction in men. This article is for informational purposes only and not to be construed as medical advice, or an attempt to diagnose or treat any illness or condition. Please consult your physician for more information.