Testosterone: Men, Here are the Medical Facts About ‘Low T’ – Without the Hype

From radio and TV ads to social media posts, there’s a lot of buzz about testosterone and something called “Low T.”  What are the medical facts behind all the hype? 

In a recent episode of the Baptist HealthTalk podcast, Michael Swartzon, M.D., a primary care sports medicine physician at Miami Orthopedics & Sports Medicine Institute, part of Baptist Health, clears up the “Low T” confusion. The podcast is hosted by Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Miami Cardiac & Vascular Institute. 

“When they say low T, the T stands for testosterone and they’re (the media ads) are lumping together a myriad of symptoms or a combination of a lot of symptoms that most commonly people get as they get older,” explains Dr. Swartzon. “And the suggestion is that possibly low testosterone is responsible for your plight or your issues.”

In those media promotions, they are not really talking about clinically low testosterone levels, says Dr. Swartzon.

“So, there is a clinically low testosterone that is in the general population … around 15 to 20 percent. And there are some things that can do to help them with their symptoms,” says Dr. Swartzon.

Check out some lively Q&A highlights from the podcast with Drs. Fialkow and Swartzon:

Dr. Fialkow:
Let’s start with some basics. What is testosterone? What’s its purpose in our body?

Dr. Swartzon:
“So, testosterone is a hormone. It’s the major sex hormone, and it plays a lot of roles in our bodies. It’s made in males; it’s made mainly in the testes or testicles. Women do have some production in the ovaries, but it’s the typical responses that you would think of in a male when they hit puberty. They get hair, they get a deeper voice, they get larger muscles, facial hair, strength, the bones grow. And a lot of times when you think of puberty, you think of kids discovering sex and going sex crazy. And again, that’s partly responsible. Testosterone is partly responsible for that aspect.”

Dr. Fialkow:
Do testosterone levels, generally, as you said, they start going up in puberty, I guess it triggers puberty.

Dr. Swartzon:
“Right.

Dr. Fialkow:
Do they continue to go up throughout your life or do they change at all as a part of natural progression?

Dr. Swartzon:
“They peak and then starting in your late 20s, early 30s, you start to see a very, very small decline. It’s less than a percent per year, but there is an overall decline with aging. Correct.”

Dr. Fialkow:
And it’s fair to say that also varies from person to person. There’s no hard and fast rule.

Dr. Swartzon:
“No, there are definitely ways that speed up the loss of testosterone and there are ways to slow it down. And some of those are intrinsic, like genetic factors and sometimes they’re things that are entirely within your control.”

Dr. Fialkow:
So, you got to start with what is low T? And what causes it? Is it a real thing? What should we be concerned about? Here’s your chance to get on your soapbox.

Dr. Swartzon:
“When they say low T, the T stands for testosterone and they’re lumping together a myriad of symptoms or a combination of a lot of symptoms that most commonly people get as they get older. And the suggestion is that possibly low testosterone is responsible for your plight or your issues, and that replacing it at this clinic will result in improvement in your life.

Dr. Fialkow:
So now we’re talking about true low testosterone.

Dr. Swartzon:
“Correct.”

Dr. Fialkow:
Meaning a clinically low testosterone level.

Dr. Swartzon:
“Right, so there is a clinically low testosterone that is in the general population, like I said, around 15 to 20 percent. And there are some things that can do to help them with their symptoms. And again, the major thing that we’re looking for is some kind of sexual dysfunction.”

Dr. Fialkow:
Is it decreased libido, decreased desire for sex? Is it erectile dysfunction, inability to perform the sexual act? Is it both? What would we define?

Dr. Swartzon:
“It’s all of the above, everything excluding — I don’t want to get into the sperm production aspect of it. I’m definitely not an expert in fertility because it can be complicated when it comes to testosterone, but specifically with what the two you mentioned. So erectile dysfunction and sexual appetite, libido, are both affected by testosterone. And so not enough of it, and you will notice it.”

Dr. Fialkow:
Now, those things can occur, not related to low T.

Dr. Swartzon:
“Correct.”

Dr. Fialkow:
So, if you’re seeing a man, whatever age, 35, 50, and they bring to your attention, or you elicit those types of complaints, do you order a testosterone level? Was that part of your workup? Would that be something that’s appropriate?

Dr. Swartzon:
“No, no, it is not. That would be a further down the line. Much more commonly the issues with sexual libido or erectile dysfunction are related to some kind of metabolic syndrome. And that’s a big group of things that have to do with how your heart and blood cells, your blood vessels, your plumbing, and your heart pump and how that works. Because without having the blood pumping to your penis, you’re not going to be able to get an erection. There’s another aspect of it that’s psychological. And then there’s a third, which can be the other category, which the testosterone would certainly fall into.”

Dr. Fialkow:
Do you see in your practice more concerns of testosterone levels by the individual in the man who’s athletic and is concerned about athletic performance — or more of the overweight diabetic who has other reasons for it?

Dr. Swartzon:
“Mostly it’s the athletes. I traditionally don’t see patients that are diabetic looking for care. I’ll see the 45-year-old coach or retired player, who’s starting to notice that their body isn’t the same and they have questions, whether it’s physical performance or sexual performance, it can be a mix, but that’s the typical patient that I see.”

Dr. Fialkow:
So, let’s take for the purposes again of this testosterone related podcast, let’s take that population. What do you speak to them about? What’s part of your assessment? What are your treatment recommendations?

Dr. Swartzon:
“Well, the advantage that I have is most of the times I know these people well, and so I can see if there’s been a difference in their behavior and their attitude, in their weight, in their size, in their performance, whether it’s athletic or in their job. So, I can notice if they’ve had less energy, less endurance, and any of those things can sometimes be obvious to a physician that knows you. But otherwise, it’s a lot of talking, a lot of finding out what’s going on with someone is their history, right? The subjective part. And you tell me what your symptoms are. And then I ask you more about them, and we go through it one at a time.”