by Dr. Karl Nadolsky
Many men come to my office wanting “testosterone shots/gels.” The problem is that not all of them qualify for supplemental testosterone. You should only get replacement/supplemental testosterone if you are:
- Truly deficient (hypogonadal) – Labs showing that you have low testosterone (generally lower than the normal range or at the low end of normal)
- Showing signs and symptoms of low testosterone (hypogonadism/andropause/etc) – Lack of libido, decrease strength and staying power of erections, lack of morning erections, lack of energy/strength, and even some depression.
Using these guidelines, I as a physician can tease out who really needs some more testosterone and who is just being greedy. With that being said, it is VERY important to treat those who do fit these guidelines. The impact of testosterone replacement in those who are low will bring their “mojo” back so to speak. In fact, it can go as far as helping them lose fat and trim inches off their waist line! You can read more about the study here.
The researchers took 255 guys who met the hypogonadal guidelines I listed above and started giving them shots (testosterone undeconoate, which isn’t available here in the US yet) for 5 years. The average weight loss was 36 pounds! This may not seem like much but considering these folks weren’t even counseled on weight loss strategies makes that number very significant. The average waist measurements also went down by 3.5 inches which is obviously great as well.
Now I will say that much of this low testosterone is as a result of the growing obesity epidemic. The increased amount of belly fat (and excess fat altogether) causes an increase in estrogen levels and a decrease in testosterone levels, which is beyond the scope of this article. All you really need to know is that if you have increased belly fat, you will want to do you best at reducing it with a good nutrition plan ( liker our lean habits) as well as a belly fat reducer and insulin sensitizer such as metformin or berberine.
So deciding on whether to replace your testosterone if it is low or trying to raise it naturally via weight loss is a discussion you should have with your physician. Either way, if you are a male and just not feeling like you have your “mojo” anymore, maybe you should get your testosterone checked. Schedule an appointment with your doc or consider using the Lean Doc Consulting service.
Dr. Karl says
It does continues to beg the question which we always discuss, have they created an unnecessary dependence on life-long testeosterone replacement due to gonadal atrophy? I couldn’t find the original write-up of the article so I don’t have the baseline lab values, but I wonder if most of these obese patients had obesity-related secondary hypogonadism and would be better served by stimulating their natural testosterone with clomiphene, HcG, lifestyle changes, and weight loss. That is definitely a study I would like to complete if/when I got to endocrine fellowship!
Dr. Spencer Nadolsky says
Yep. I have a follow up article that shows those who lose weight actually increase their testosterone as well as sperm quality. I think it really depends on the patient’s wishes too. The testes are pretty resilient at coming back to work after exogenous replacement as long as it is a short course. This study was a 5 year course and I am not sure if they could come back after that.
This is another reason why it is very important to treat the patient as a whole and not just lab values.