Low Testosterone Promotes Abdominal Obesity in Aging MenOctober 2010
By Julius Goepp, MD
Testosterone Levels—Early Warning of Impending Disaster
The association of declining testosterone levels with obesity, the metabolic syndrome, and cardiovascular disease is so strong that many experts now recommend checking testosterone levels to provide early warning of the metabolic syndrome.1
Testosterone deficiency has been found to be a significant and independent risk factor for metabolic syndrome, even in non-obese older men.31 It causes not only increased fat mass, but also triggers elevations in fasting insulin levels, a late marker of developing metabolic syndrome.7,32
The association of low testosterone levels with metabolic syndrome is independent of age—that is, even younger men with low testosterone are immediately at increased risk for the syndrome.33 Somewhat surprisingly, the association is also independent of BMI, pointing to testosterone’s multiple effects on regulation of glucose, insulin, and lipid metabolism.34 It has recently been proposed, in fact, that low testosterone levels be included in the very definition of the metabolic syndrome, because of the consistency with which it occurs.35
There’s an obvious implication here. Subtle deficiencies in testosterone may be present long before obesity and other more obvious manifestations of the metabolic syndrome become evident.34 That makes it vital for all men, not just the overweight or obese, to have testosterone levels checked regularly by a reliable laboratory. Be sure that both total testosterone and free testosterone are ordered—both have been associated with metabolic syndrome.35
When having your blood tested for total and free testosterone, make sure you also order tests for PSA to rule out existing prostate cancer, estradiol to determine whether you need to take an aromatase inhibiting drug in case estrogen levels are too high, and a CBC/chemistry test to measure liver function and blood cell counts.
Restoring Healthy Testosterone Levels
What should you do if your testosterone level comes back low? There’s a growing body of evidence suggesting that careful testosterone replacement therapy is protective against many features of the metabolic syndrome and can enhance blood sugar control.36 Given early enough, testosterone therapy may slow or even halt the progression from early metabolic syndrome to diabetes or cardiovascular disease.17 In one study of diabetic men with low testosterone, oral treatment improved their glucose control and decreased their abdominal obesity. A beneficial side effect was reduction in erectile dysfunction.6 Other placebo-controlled studies have shown decreases in whole body, total, and subcutaneous abdominal fat mass, accompanied by increases in lean body mass, as a result of testosterone therapy.8
Of course it’s important to check and to follow testosterone levels when considering treatment. Achieving testosterone levels within the existing reference ranges may not be sufficient to combat obesity and metabolic syndrome. Some testosterone-dependent biological functions require higher levels than others, and those thresholds differ among men.37
Finally, a word about testosterone therapy and the risk of prostate cancer. For decades we believed (and some still do) that higher serum testosterone concentrations contribute to the risk of prostate cancer. More recently, considerable data have emerged suggesting a more complex picture, and indicating that in fact testosterone therapy may not be nearly as risky as once assumed.38 In fact, according to Dr. Abraham Morgentaler of Harvard’s Beth Israel Deaconess Medical Center, “One of the more interesting changes over the last several years has been the growing acceptance of the use of testosterone therapy in men with a prior history of prostate cancer, with early data indicating minimal risk of cancer recurrence or progression.”38 Other experts in the field agree that the risks of testosterone therapy are often exaggerated and should not outweigh the benefits of treatment.21
Indeed, Dr. Morgentaler goes on to note, new evidence suggests that it is not high, but low serum testosterone that is responsible for many features of prostate cancer risk.38 Since we now know that low testosterone causes obesity, and we further know that obesity is a risk factor for cancer,39,40 there is certainly a logical basis for the idea that low testosterone is indirectly a cancer risk factor.
Testosterone and body fat content have an intricate and bidirectional relationship. Excess body fat causes low testosterone, but low testosterone also causes excess body fat. Testosterone regulates many facets of energy balance, with an especially powerful impact on glucose, insulin, and fat metabolism. The deadly results of low testosterone therefore exceed simply causing obesity. Low testosterone also dramatically raises men’s risk for the metabolic syndrome, a major health threat for anyone at or beyond middle age. Experts now recommend regular testing for any man at risk for low testosterone, including aging men.1 If your testosterone levels prove to be low, you should consider testosterone treatment in consultation with a physician.
If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.
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