by Craig Koniver

Have you noticed all of those commercials on television and radio for testosterone? It seems as if in the past year alone, those types of commercials have sprung up out of nowhere.

I find this interesting for a few reasons and I think you should too.

It was only a few years ago that scientists declared that the end of the Y Chromosome was upon us.  This is strange to ponder: the essence of the male species evolving away over time?

Testosterone, the primary male hormone, is known to decrease in most men 1% a year starting at around age 30.  And so for the majority of men who are aging, this is very real. Studies show that men who have a loss of testosterone commonly experience weight gain, depressed mood, fatigue, low libido, difficulty concentrating, poor memory as well have an increase risk of both heart disease and stroke.

Unfortunately, these longer term effects of testosterone are not conveyed very well to the masses of men. For the most part, what we hear and see about testosterone is about getting “pumped up” and increasing libido. To me, this is more than just a shame.

My personal experience with testosterone replacement therapy with thousands of men in my practice over time is that for most men, testosterone replacement is not only safe but greatly appreciated. For the little things.

Most men I prescribe a form of testosterone replacement come back and tell me how much better they feel in general and how well they can now think and how much more confident and happy they feel.

I know, I have an extremely small sample size – and no control group, but, as a practicing physician, my patient’s increase in well being, and certainly their gratitude is real nonetheless.

But I do have two questions:

1) Why do we neglect women in our discussion of testosterone?

2) Why are the many long-term benefits (decrease in heart disease, stroke, dementia) of testosterone neglected to be conveyed?

Yes, testosterone is the primary male hormone, but is also a significant hormone for women too. It is well established that as women age and enter menopause their ovaries go into retirement and give up the role of testosterone (and estradiol and progesterone) producer to the adrenals. As such, many women experience a decrease in muscle mass, weight gain, loss of memory and brain fog. Is this just the effects of aging? Or do women benefit from testosterone replacement as well? Here is a summary article from the Journal of Endocrinology and Metabolism citing some positive effects of testosterone replacement in post-menopausal women.

My opinion is that testosterone replacement in women is not widespread at all as most doctors either only think of testosterone replacement for men or for libido purposes. But testosterone, in my opinion, is just as important in women, as it is in men.

And there are many other natural options to boosting testosterone (the use of the herb Vitex, for example) besides testosterone replacement that a physician and patient can turn to.

But the idea that testosterone is just for men and just about libido is absolutely ludicrous.

Getting to my second question about why the long term benefits of testosterone are often ignored, my opinion there is that testosterone has gotten a bad rap from its abuse by professional athletes and bodybuilders. So when most of us think of testosterone, we think of some big jock-type male walking around with big muscles. But I think we are savvy enough now to put those conotations aside and see the big picture. The complete picture.

Testosterone is truly a needed hormone for both men and women. And here is my last thought about this: testosterone is an intermediate hormone either metabolizing into estradiol or into DHT. Most of the studies that look at testosterone’s role in health fail to understand this. And as such,  when you are only looking at one piece of the pie, results will be skewed.

We are living at a time when hormonal influence (from pesticides, herbicides, fungicides, chemical solvents, plastics, etc.) are at an all-time high. We as humans have never been exposed to so much “hormones” ever. And so to help our patients understand and navigate the aging process, we must take this notion into account. Testosterone is powerful, but it is an intermediate hormone and failure to understand the entire hormonal milieu can results in bad outcomes: for example, giving men testosterone replacement will result in an increase in estradiol levels. And since estradiol is pro-inflammatory, this can lead to bad outcomes (if you look at men with prostate cancer, they tend to have low testosterone levels and high estradiol levels). So any regimen to boost testosterone must take this into account.

As you can tell, this entire hormone arena is nothing short of extremely complex and complicated. But I think we owe it to ourselves to fully understand all of it. Because as much as many of us cringe at the idea of hormone replacement, hormones are extremely influential in how we feel in the short term and long term.

Two final points. To throw more confusion at you regarding testosterone, I recommend you read the book by Richard Sapolsky titled: The Trouble With Testosterone. In these essays one of his findings in animals is that the “worst” place to be is either at the top of the animal hierarchy (the Alpha male) or at the bottom. The best place from an outcome perspective is right in the middle. A really fascinating book.

And lastly, good news for you men out there, the Y Chromosome is no longer disappearing……


Patricia Salber MD, MBA (@docweighsin)
Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. She is also the CEO of Health Tech Hatch, the sister site of TDWI that helps innovators tell their stories to the world. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare.


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