Jerry Nolasco was running on empty. He worked hard for several years to lose more than 40 pounds, but at 5 foot 9 and 240 pounds, he still had a way to go. Daily fitness walking around his Pasco County neighborhood plus a full-time job zapped all his energy.
Then, as he was getting into his late forties, he started having problems with memory and concentration at work. A magazine article about age-related changes in male sex hormone levels sent him to the doctor. After testing, he learned he had low testosterone, a condition you may have seen trumpeted on billboards around town as Low T.
Just as women notice physical and emotional changes when the hormone estrogen starts to decline, many men experience noticeable changes when testosterone production dips, although they may not attribute it as readily as women to hormonal changes.
Symptoms of Low T include hot flashes, fatigue, moodiness, trouble sleeping, difficulty concentrating and less interest in sex. All of which may sound a lot like menopause. But menopause marks the end of fertility in women — which is not necessarily the case with men — so there really isn't such a thing as "male menopause.''
Plus, while every woman who lives long enough will experience menopause, most men don't truly have Low T — and even some who do have it don't experience troubling symptoms.
Until recently, most men didn't know there was such a thing as Low T. But thanks to heavy advertising — often for unproven over-the-counter elixirs — men are more aware than ever, doctors say.
"We're seeing a wave of men in tune with their health, some as young as their 30s asking about (testosterone) and many in their 40s," said Dr. Rafael Carrion, an associate professor of urology and director of sexual medicine and research at USF Health.
"Testosterone has a big job to do in the body. It affects so many systems. That's why it's considered a fundamental hormone and should be in the appropriate range," said Carrion.
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Testosterone starts declining in a small proportion of men as early as their 30s. By the time they reach their 60s, up to 25 percent of American men have Low T, but it doesn't always cause symptoms.
Nolasco, however, felt miserable.
"I was 49 and I felt like I was 80," he said.
Routine health checks found nothing wrong —but no doctor had ever checked his testosterone level.
Diagnosis of Low T is based in part on a simple blood test. But the results are anything but simple to interpret. A normal level of testosterone ranges from 300 to 1,000 nanograms per decileter. So it's no wonder that doctors differ on how to interpret test findings.
"I find that men with symptoms will go to their family doctor who checks their testosterone and if it falls anywhere in that range, they say it's normal and you're just getting older," said Dr. Stephanie Bien, founder of the Executive Med-Club of Tampa, specializing in age management for men and women.
Bien (pronounced bean) says the key to diagnosis is asking a lot of questions about lifestyle and performance — on the job, in the gym and in the sack. "I treat the symptoms, not the lab value," said Bien.
Most physicians use nationally accepted questionnaires developed by endocrinologists and other medical groups to help diagnose Low T. The questions are related to lifestyle, sexual performance and mood.
If blood testosterone is 350 to 400, for example, but the patient has no energy, is irritable, can't lose weight or multi-task like he used to and has lost interest in sex, he might benefit from testosterone therapy.
The classic presentation is a guy in his '40s with low libido, but symptoms vary and can include issues with memory, concentration, problem solving, lack of motivation, or depression.
"It may be just one symptom, so patients may ignore it and think they're working too much or getting older," said Carrion. "And that's a shame because there is viable treatment available."
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First though, doctors must check for prostate cancer. Testosterone therapy is not thought to cause cancer, but may stimulate its growth if it's already present.
Testosterone therapy may worsen sleep apnea and symptoms associated with BPH, benign prostatic hyperplasia or enlargement.
Doctors must also monitor red blood cell production because testosterone therapy may boost it to dangerous levels. And it should not be used by men with breast cancer.
Doctors will also want to rule out other possible causes of symptoms, such as abnormal thyroid, insulin, or iron levels; heart disease, diabetes, a pituitary tumor, some cancers and cancer treatment; and an injury or infection in the testicles or a rare birth defect or genetic condition.
"But 90 percent of the time, it's Low T" simply from aging, said Bien. She also looks at patients' diets, whether they exercise regularly, sleep well and manage stress.
"There usually are other contributing factors that need to be addressed," to get patients feeling and performing better, she said.
Nolasco, who is Bien's patient, started testosterone replacement therapy about two years ago, an injection he now gives himself once a week. "It made a world of difference," said Nolasco, now 51.
He now weighs 170 pounds, is in the gym at 5 a.m. every day, puts in a full day of work as chief security officer at a St. Petersburg investment firm and walks 3 miles every evening with his wife, Iris, 48. The couple, with daughters Nicole, 24, and Gina, 10, live in the Trinity community.
"Hormone therapy allowed me to take my fitness to the next level. Plus, I'm much mentally sharper at work than I've ever been," said Nolasco,
"I'm not forgetful. I pick up things much quicker. I'm more patient. You feel youthful. It's like having the energy and strength of an 18 year old with the wisdom and knowledge of a 50-year-old man."
Testosterone therapy has the added benefits of increasing muscle mass and bone density, which can keep men active and prevent fractures as they age.
A testosterone check isn't usually included in routine blood testing. Carrion thinks it might be a good idea for men to get baseline checks in their 20s, though others disagree with that notion.
Experts do agree, however, that men should avoid products sold over the counter, on-line and by mail order that promise to improve symptoms of Low T, in particular sexual function.
At best, they are likely a waste of money. "Some are potentially dangerous and have been pulled from the market," said Carrion, "Plus, there's no science to prove that they work."
Irene Maher can be reached at firstname.lastname@example.org.