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Men’s Health: Testosterone and Chronic Conditions

It is well known in the healthcare field that men’s health concerns are frequently overlooked. For years society has implied, and in many cases blatantly suggested, that men “man up”, leading to what many practitioners consider a silent epidemic in healthcare. Men often delay seeking care with studies showing men are significantly less likely to use a primary care physician than women, even after an event requiring hospitalization (1). Specific reasons for this can vary with socioeconomic status, education level, support systems, and societal pressures playing a role. In the integrative world, practitioners emphasize the importance of their patients recognizing their unique needs, with male-specific risk factors taken into consideration. Being efficient and targeted with male-focused healthcare will hopefully improve these outcomes with increased use of primary care and preventative options. One way this can be done is through successful interactions between patients and doctors, with tangible improvements in health status.

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Practitioners of preventative medicine are proponents of all individuals receiving yearly physical exams and lab evaluations. When it comes to male specific concerns, much of this focus will be on screening for metabolic and cardiovascular disorders, as cardiovascular disease is the leading cause of morbidity and mortality. As it is with any patient, screening is done through monitoring blood pressure, testing cholesterol and blood sugar levels, reviewing diet and lifestyle, and discussing stress management. All of these things are very telling of baseline health status, but newer research indicates further lab evaluation may be warranted in male patients to have a stronger understanding of what interventions will be most effective.

When it comes to men, they differ heavily from women in one area: hormones, specifically in expected levels of testosterone. Functional and integrative practitioners have started to more routinely order serum testosterone for total levels and salivary testosterone for free, bioavailable fraction, with many pushing for the standard of care regarding yearly evaluations to include this important level. Though the exact reference range can differ slightly depending on the lab, a normal measurement is considered between 300 and 1000 ng/dL or 10-35 nmol/L (2) in serum and between 10 and 61 pg/mL in saliva, with deficiency of this important hormone in men being the main concern.

The prevalence of testosterone deficiency worldwide is reported as 10-40% of men, with risk increasing as one ages (3). Well recognized symptoms in adults assigned male at birth include low sex drive, erectile dysfunction, depressed mood, and fatigue. However, low testosterone also can have a significant impact on metabolism. Large epidemiological studies have repetitively shown a relationship between deficiency and the presence of obesity and/or the onset of metabolic disorder and type 2 diabetes (4).

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In regards to obesity, low serum testosterone levels can predict the development of visceral fat, or “central obesity”, which preventative medicine practitioners regard as the most dangerous type of weight gain when it comes to the development of chronic diseases. Usually, this type of weight gain is related to metabolic disorder and type II diabetes onset anyway, but interestingly enough low testosterone has also been associated with the onset of metabolic disorder and type II diabetes regardless of age or current presence of obesity. Unfortunately, once obesity is present, testosterone decreases further, creating a vicious cycle that is sometimes difficult to resolve (4).

A similar association was found between low testosterone and cardiovascular disease risk. Multiple studies have provided evidence that low serum testosterone is associated with increased risk of cardiovascular disease independent of age, obesity, hyperlipidemia, and lifestyle in men with or without metabolic syndrome/type II diabetes. These researchers have even shown higher rates of cardiac-event related death in the testosterone-deficient men compared to those with cardiovascular disease and normal testosterone levels. (4). Therefore, knowing testosterone levels can provide a more detailed view of health status in male patients.

Due to these correlations, many practitioners of preventative medicine are proponents of serum and/or salivary testosterone screening during yearly blood work evaluations. The reach of testosterone actions are much broader than just metabolic and cardiovascular concerns, with effects on mood, stress management, exercise success, and sexual health. Therefore, this lab value provides essential information in male patients, who may frequent the doctors less, giving an efficient and easy snapshot into health status. Hopefully, including it in yearly panels more regularly will give practitioners a place to intervene that targets numerous aspects of health, improving male-specific health outcomes. Testosterone and other hormone levels can easily be evaluated using saliva-based tests that are highly precise and painless. AYUMETRIX is a world leader providing hormone testing in saliva, which is simple and convenient. The samples can be self-collected at home and mailed to the laboratory for analysis. To learn more about hormone testing in saliva, please visit www.ayumetrix.com.


- Mary Hall, ND, LAc


References:
1. Hohn, A., Gampe, J., Lindahl-Jocobsen, R., Christensen, K., Oksuyzan, A. 2020. Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in primary healthcare use after first hospitalization at ages 60+ in Denmark. J Epidemiol Community Health. 74(7): 573-579.
2. “Testosterone” Mount Sinai. https://www.mountsinai.org/health-library/tests/testosterone.
3. Anaissie, J., DeLay, K.J., Wang, W., Hatzichristodoulou, G., Hellstrom, W.J. 2017. Testosterone deficiency in adults and corresponding treatment patterns across the globe. Transl Androl Urol. 6(2): 183-191.
4. Wang, C., Jackson, G., Jones, T.H., Matsumoto, A.M., Nehra, A., Perelman, M.A., Swerdloff, R.S., Traish, A., Zitzmann, M., Cunningham, G. 2011. Low testosterone associated with obesity and metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type II diabetes. Diabetes Care. 34(7): 1669-1675.

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