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Though many men have been convinced by the drug manufacturers marketing that low testosterone levels should be “fixed” with gels, patches, and injections, science shows that testosterone levels natural decline as a man ages, and that lifestyle factors, as well, can influence them.

And while drugs like AndroGel and Androderm have become very popular over the last few years, mostly due to advertisements that give the impression these drugs help men to feel younger, a 2015 study reported that after three years, men taking the drugs did not experience improvements in sexual dysfunction, sexual desire, or quality of life that were any different from men not taking the drugs.

Meanwhile, many doctors remain concerned that testosterone drugs could increase risk of cardiovascular problems, as a number of studies have indicated that they may increase risk for heart attack and stroke.

“Low-T” Sold as a Disease to Middle-Aged Men

According to the Mayo Clinic, testosterone levels usually peak around early adulthood, and then gradually decline after the age of 30-40 years. Declining testosterone levels are not necessarily associated with signs of aging, such as changes in sleep patterns and sexual function.

To suggest that declining testosterone levels is a type of “disease” that needs treatment is “selling a disease,” according to professors of medicine Steven Woloshin and Lisa M. Schwartz from the Dartmouth Institute for Health Policy and Clinical Practice. In their Washington Post editorial, they noted that prescriptions for testosterone replacement products increased nearly ten-fold after manufacturers launched so-called “disease-awareness” campaigns that urged middle-aged men who wanted to become more energetic and muscular to ask their doctors about “low-T.”

A few years later, studies started popping up that linked testosterone to cardiovascular risks. On January 31, 2014, the FDA released a public safety communication announcing they were investigating the potential link between these drugs and adverse cardiovascular events, and in March 2015, they released a follow-up communication noting that testosterone product labels had been updated to include a warning about a “possible increased risk of heart attacks and strokes in patients taking testosterone.”

This all came too late, however, for many men who were lured in by the advertisements and then suffered heart attacks and strokes.

Many Other Reasons for Low-T

The FDA approved the use of testosterone only to treat men with hypogonadism, a medical condition that is associated with low testosterone levels. These drugs were never cleared to address the symptoms of aging, but studies have revealed that large numbers of men started taking them without ever being tested for true hypogonadism. A 2014 study reported that 40.2 percent of U.S. men did not have a testosterone test at all in the 180 days before beginning therapy.

Meanwhile, doctors have recommended that men who are experiencing symptoms of hypogonadism—even if they test low for testosterone—be tested for other potential health conditions that can lower testosterone levels, like chronic illnesses, long-term use of some medications, high alcohol intake, eating disorders, obesity, or even excessive exercise. Often simple lifestyle adjustments can bring testosterone levels back within the normal range without the significant risks of testosterone replacement drugs.

Erectile dysfunction, as well, is common in men over the age of 40, and caused by many factors, including, vascular diseases, some medications, and psychosexual factors, which are more often to blame than low-T, and for these men, a testosterone prescription won’t help anyway, but may expose men to unnecessary cardiovascular risks.

Men who already have some risk factors for cardiovascular disease are even more vulnerable to testosterone replacement side effects, and should be particularly careful about starting any such prescription.

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