Do you know your T-score? That’s ‘T’ as in Testosterone. There’s a nationwide campaign that’s especially hot in Texas urging men to check their testosterone levels and get treated for what’s become known as "Low T. " We dive into the details behind testosterone replacement therapy.
The number 294 is pretty impressive when you're talking career receptions as a fullback. It's not such a great number when you're talking testosterone. That’s what three-time super bowl champ Daryl “Moose” Johnston found out last year at the doctors.
Johnston had been feeling more tired than usual, he was having trouble finishing bike rides around Dallas’ White Rock Lake that used to be easy, and had a hunch it wasn’t just the result of getting older.
Turns out he was right. Blood tests showed Johnston has low testosterone. Now, he’s teamed up with pharmaceuticals company AbbVie to raise awareness for hypogonadism, or low T.
He’s not the only one getting the word out about low T. Companies have plastered advertisements and bought radio spots across for low testosterone treatments across the country.
In the last decade, the percentage of men being treated for low testosterone more than tripled, according to a study in JAMA Internal Medicine conducted by researchers at the University of Texas Medical Branch. It’s never been easier to start testosterone replacement therapy – there are gels, patches, shots, even tablets.
Dr. Steven Woloshin and Dr. Lisa Schwartz of the Dartmouth Institute for Health Policy & Clinical Practice, call the low T campaign "a mass uncontrolled experiment."Woloshin says drug companies convince people they need treatment for diseases like low T by following three basic marketing steps.
- Capitalize on vague symptoms: “If you fall asleep after dinner, if you feel like you’re slowing down in sports, that’s enough to get you in to the realm of talking to your doctor about low T,” Woloshin says.
- Raise the stakes: “So people want to get tested because you make them feel like it is dangerous not to,” he says.
- Spin the evidence: "So you make it seem like treating it is more beneficial than it probably is."
But this isn’t all propaganda. Testosterone deficiency is a real disease. It’s just there’s little consensus on what levels are considered abnormally low, and which patients actually need supplements.
Lack Of Low T Studies
Dr. Karen Herbst, an endocrinologist and associate professor at the University of Arizona, says we still do not understand testosterone replacement therapy very well.
“We don’t understand exactly how much testosterone we should replace and we don’t understand the long term side effects,” Herbst says.
Unlike menopause in women, where it’s normal for estrogen levels to plunge – testosterone levels in men are supposed to decline only slightly after age 40. A healthy “T” score falls anywhere between 250 and 1,100.
[More from KERA News: The Estrogen Debate Continues]
Herbst points out there are many variables that can lower a man’s testosterone. Anything from a serious thyroid condition, to anxiety (even fatherhood), to obesity.
“For example if a man has sleep apnea, his testosterone is low. If you treat the sleep apnea, the testosterone will come back,” she says. “Same for obesity, if we can get him to lose weight then his testosterone will come back up.”
Herbst, like other endocrinologists, has prescribed testosterone to help patients lose weight. She says it can work for some patients, but acknowledges the Food and Drug Administration hasn’t approved testosterone to improve strength, athletic performance, or energy levels. The largest study on testosterone to date, a trial involving 230 patients in the Netherlands in 2008, showed no significant improvement in muscle strength or cognitive thinking.
Testosterone therapy has been shown to provide small improvements in lean body mass and body fat, libido, and sexual function.
The Low T Empire
Mike Sisk owns 31 testosterone replacement clinics across the country – a dozen in Dallas-Fort Worth alone. Each clinic is geared towards the busy executive male – rooms are sports themed, photos of the Mavericks and Texas Tech hang next to stethoscopes. And their waiting room at the Southlake headquarters is called the “Man Cave.”
“We probably see 100 patients here a day,” Sisk says. Total active patients across the country is 15,000.
Sisk built his empire after he was diagnosed with low T four years ago, and couldn’t find a place to get injections that was fast and easy. Here, routine visits rarely last longer than NFL halftime.
For a new patient, its 40 minutes.
The patient comes in, gets blood drawn and analyzed in-house, and then has a quick physical. If his levels are below 350, and the doctor doesn’t find any other serious health conditions, he can get treatment right away. The cost is $395 a month.
The search for a youth serum also draws in men who aren’t good candidates for testosterone replacement therapy.
Dr. William Reilly, medical director of the Low T Centers in the Dallas area, says they turn away or refer to specialists 50% of the men who come in. That’s in part because many have high PSA levels, which could indicate prostate cancer. And prostate cancer thrives on testosterone.
Steven Woloshin explains there are also other serious risk for testosterone takers, such as heart attacks or blood clots.
“So this is serious stuff," Woloshin says. "People don’t want to get involved with taking this drug unless there is a really good reason for it.”
Right now, prescribing testosterone is a balancing act. Woloshin says the onslaught of campaigns making testosterone look like a sexy cure-all may be tipping the scale toward treatment.