At least, that's what a torrent of television and print ads from the makers of testosterone replacements would have you believe. "Millions of men 45 or older may have low T," warns one such ad. "So talk to your doctor about low T."
Considering how most men feel about muscle and sex drive, the result has been predictable. A 2013 study in JAMA Internal Medicine found testosterone prescriptions grew more than threefold between 2001 and 2011. Data from IMS Health shows T sales rose from $324 million in 2002 to nearly $2.3 billion in 2012. Sales could hit $5 billion by 2018.
But is low T from aging really a disease in need of medication? Critics of the campaign say many men have been convinced to take a potentially risky drug for a condition they don't have. Steven Woloshin, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, dubs low T "the mother of all disease mongering."
If You See a Doctor
- Skepticism helps: Avoid clinics that appear to be in the business of writing prescriptions for testosterone therapy and nothing more.
- Transparency counts: A good doctor will prescribe T therapy only if it's medically warranted, and will be frank about risks and rewards.
- Testing matters: Before prescribing, a doctor should test your T twice, on separate days, to get an accurate baseline. If you're on T therapy, it's important to get follow-up tests to track T levels and adjust dosage.
On the other hand, proponents say testosterone replacement can help older men improve their quality of life. "The true outrage is that social forces and hysteria have combined to deprive men of a useful treatment without regard for medical science," Abraham Morgentaler, a Harvard urologist, wrote recently in the Journal of Sexual Medicine.
The truth about low T
Experts agree on at least one thing: After age 30, every man's testosterone drops about 1 percent a year, according to Ranjith Ramasamy, a urologist at Baylor College of Medicine in Houston. Being overweight or obese, as well as having type 2 diabetes, may drag your levels down even lower.
But what is a healthy T level for an older man? Doctors can't agree. Many laboratories use wildly varying reference numbers based on the average testosterone levels of young men, anywhere from 300 to 900 nanograms per deciliter.
Meanwhile, some symptom lists virtually guarantee that any middle-aged man will self-diagnose low T. Several websites that promote testosterone replacement feature a 10-question self-quiz. Answer yes to just three — you're grumpy now and then, you don't have the strength you used to have, and you sometimes fall asleep after dinner — and you could have low T. "These complaints may have nothing to do with testosterone," says Woloshin.