Testosterone: The Driving Force Behind Power, Sex, and the Will to Win

By Dr. Chester Lee, MD

Photo Credit: Newsweek

On May 8, 2015, Newsweek published a review titled “Testosterone: War, Sex, Money, and Men.” The book reviewed, authored by Cambridge University neuroscientist Joe Herbert, carries the more provocative title, "Testosterone: The Driving Force of Power, Sex, and the Will to Win." In popular science, the relationship between testosterone and masculinity seems inseparable. Anthropologists assert that this minuscule hormone has influenced not only modern society but also the rise and fall of ancient empires. Meanwhile, modern egalitarian and feminist activists regard it as a root cause of today’s inequalities. Nonetheless, while testosterone and masculinity are invariably linked, there are subtle medical nuances to consider.

Testosterone and Its Role

Testosterone (hereafter T) is a steroid hormone built from cholesterol. While it is primarily produced in the male testes, it can also be synthesized in the adrenal glands, ovaries, and placenta (during pregnancy). T is a crucial hormone for men, influencing various bodily functions:

1. Stimulates erythropoietin (EPO), promoting red blood cell production in the kidneys.
2. Increases muscle mass and strength.
3. Maintains bone density, growth, and marrow formation.
4. Supports brain function, cognition, memory, emotion, and libido.
5. Aids skin health, hair growth, and collagen production.
6. Supports genital growth, sperm production (fertility), and erectile function (ED).

The last point mentions erectile function. Men often attribute low T levels to erectile dysfunction, but it is also linked with symptoms like:

1. Loss of muscle mass.
2. Decreased facial and body hair growth.
3. Fatigue.
4. Difficulty concentrating or getting restful sleep.
5. Persistent challenges in maintaining weight.
6. Reduced physical endurance.
7. Workplace difficulties, depression, memory loss.
8. Decreased libido or erectile dysfunction.

This condition, known as hypogonadism, dictates that erectile dysfunction is neither the only nor the primary symptom of low T. Hypogonadism usually requires treatment when blood tests show T levels drop to 300 ng/dL, typically conducted in the early morning when levels are at their peak. There are preventative measures to consider in treatment, crucially that T replacement therapy (TRT) is not prescribed to men planning pregnancy, as exogenous TRT can halt sperm production in the testes. Despite historical concerns of increased prostate cancer risk, recent studies affirm TRT safety, with success rates tripling over the past decade.

Most Common TRT Forms:

• Transdermal: Patches, gels, creams.
• Injections.
• Long-term pellet implants.

As TRT is a regulated substance, a physician's prescription is necessary. Post-therapy, symptom improvement and normalized serum T levels may take 2-3 months, requiring regular monitoring of T levels and basic blood tests like PSA for prostate cancer screening.

Causes and Consultation

The causes of hypogonadism range from age-related androgen deficiency in older men to genetic diagnoses, such as Klinefelter syndrome (patients born with an extra X chromosome). It's advisable to consult with an endocrinologist or urologist. While TRT can assist some with low T-related erectile dysfunction or reduced libido, others may not respond positively to treatment. Typically, 40% of men experience lowered T from age 40, with a further 10% decrease every decade. Though age-related, this deficiency is treatable for personal and relational well-being.

In conclusion, is testosterone truly the hidden catalyst behind every power struggle and human affliction? Perhaps. The critical takeaway is harnessing it through appropriate treatment—not for war, but for love.

Sources:

1. AUA guidelines: Evaluation and Management of T Deficiency. JP Mulhall, et al., Feb. 2018.
2. Endogenous and exogenous testosterone and the risk of prostate cancer and increased PSA level: a meta-analysis. P Boyle et al., BJU Int, Nov. 2016.
3. Trends in Androgen Prescribing in the USA. J Baillargeon et al., JAMA, June 3, 2013.

Dr. Chester Lee, MD

President, AKAM 2019-2021 Urological Specialties

177 North Dean Street, Suite 305, Englewood, NJ 07631

201-569-7777