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Low-T Treatments Are the Rewards Worth the Risks?


By Amy Kennard

You’ve probably heard the commercials about low-T. There are plenty of pharmaceutical companies and medical practices offering drugs, supplements and hormone-balancing treatments that profess to replenish a man’s youth and virility of which low-T has robbed him. But like many “cutting edge” treatments offered as one-offs by doctors not necessarily practicing within their field, all signs point to proceeding with extreme caution.

The Lowdown on Low-T
Low-T, also called hypogonadism, is when a man’s testosterone level decreases, resulting in symptoms such as fatigue, sexual dysfunction, declining muscle mass, and body fat gain. Testosterone supplements have long been prescribed to men suffering from low-T, and have also been approved by the FDA to treat certain medical conditions in men that may — as a result of their condition — cause low levels of testosterone such as damage to brain areas that control production of the chemical. However, because the drug is FDA approved, doctors have been given cart blanche to prescribe it simply for symptoms that are concurrent with the aging process, like low sex drive or lack of energy.

Dr. Bradley Anawalt is an endocrinologist and professor of medicine at the University of Washington, in Seattle, and says, “Typically, a man’s testosterone levels slowly decline with age. And there is a ‘rough correlation’ between that decline and symptoms such as sexual dysfunction.” He continues, “However, it’s not clear whether low-T or other factors — such as chronic health conditions, medications, or the aging process itself — are to blame. And it’s unlikely that men with modestly low testosterone levels would get any benefit from supplements.”

In many cases, these low-T treatments are prescribed by doctors who are board certified in another specialty entirely. In fact, the American Board of Medical Specialties doesn’t even recognize the field of anti-aging as a specialty, meaning physicians cannot officially become board certified in that area. The result? Practices and “anti-aging clinics” are dabbling in a lucrative yet potentially dangerous area, especially if they are doling out low-T medications for the wrong conditions or without full knowledge of side effects or the patient’s full medical history.

Todd’s Story
Todd is 33 and though he was in good overall physical health, he had been suffering for several years with bouts of depression, low energy, hair loss and weight gain. His primary care physician diagnosed him with borderline low testosterone, but didn’t believe that it was low enough to start treatment. It was recommended that he exercise and lose weight and re-evaluate the symptoms in six months. A co-worker with similar issues suggested a local clinic in which he had found success. Run as a separate entity from the physician’s practice, the clinic advertised relief from symptoms like Todd’s and promised increased virility and energy, weight loss, and possible hair regrowth using hormone therapy.

Todd’s treatments included prescription medications and injections of testosterone as well as estrogen blockers that cost him more than $200 a month. Since testosterone increases your red blood cell count, Todd was required to have a blood draw when his red blood cell counts reached a certain level, since too many red blood cells cause the blood to thicken and can cause excessive headaches. It was then, Todd said, that he began suffering from migraines so severe that landed him in the emergency room on multiple successive occasions. Prior to his treatment, he had never had a migraine. “When the treatments first started,” said Todd, “I felt better and more energized. Then all of a sudden I woke up one day vomiting with a severe migraine and was so disoriented I thought I would fall.”

Unfortunately, Todd’s physician at the clinic did not have privileges at the hospital where Todd was admitted, so he could not consult, see, or treat him. However, when Todd tried calling the clinic to explain what was happening, the clinic physician didn’t see any correlation of his symptoms to his Low-T treatments, nor did he disclose that there would be side effects from abruptly stopping treatment at the hospital. As a result, the hospital did not have the information to take into account that Todd’s testosterone treatments could have been the culprit. Instead, he endured an MRI of his brain, a spinal tap, oncology consults for blood cancer, antibiotics for a nasal infection, psychiatry visits for a depression profile, and a three week hospital stay — all the while enduring excruciating headaches and not knowing what was causing them — not to mention the time spent away from work. During and after the hospital stay, Todd felt abandoned by the clinic physician. Without a physician recommendation, his testosterone treatments stopped and he began experiencing severe withdrawal symptoms that lasted for months. 

“For people with truly low testosterone levels, the benefits (of treatment) may outweigh the risks,” said Dr. Anawalt. “But for millions of others, it’s in the same category as snake oil.” He continued, “There are what I would label ‘testosterone factories’ out there, and it’s terrifying because we don’t know what the long-term safety profile is.”

A Cautionary Tale
The moral of the story? “Check to see if and where the physician treating you has hospital privileges should problems arise,” said Todd. “I was under the impression that since the clinic I attended was headed up by an MD that I was under good care,” he said.

It’s also a good idea to check to see if the physician you are considering is board certified in your particular area of concern and therefore qualified to treat your specific condition. People may not realize that most states, including Illinois, do not have any laws that prevent doctors from practicing outside of their field.
Also, Todd suggests, ask a lot of questions. “I had no idea that these treatments could have the side effects that they did, and I’m not sure the clinic physician did, either. It was a very hard lesson to learn.”

Photo credit: monkeybusinessimages/iStock