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.”
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