If your testosterone is low you’re going to get fat.
This is the title of my upcoming book. It’s a catchy title, and I want to tell you a little bit about it. This is such an important subject that I don’t want to wait until the book is edited and finally gets printed to share it.
There’s been increasing understanding between the connection of low testosterone and weight gain. Questions have remained such as, “which came first, the low testosterone or the weight gain?” It turns out they are interconnected. Low testosterone leads to weight gain, and weight gain leads to low testosterone. It’s a vicious cycle.
Unfortunately, most men who are gaining weight or becoming obese are not offered evaluation for low testosterone.
Amazingly, despite extensive medical research over the past 20 years demonstrating that low testosterone not only leads to weight gain and obesity but also prediabetes and diabetes, scientists are still repeating studies to prove what is already known.
A 2016 study from Poland evaluated men between 48 and 80 years old with clinical findings of prediabetes, which is a situation where the blood sugar is above normal but not quite to the diabetes range.
There were about 200 men who were obese or overweight in the study. About half of them had prediabetes and half were healthy. They tested blood sugar and glucose tolerance as well as other tests of prediabetes, and they also tested testosterone level along with other similar hormones.
The study found that consistently, the men with prediabetes had substantially lower total and free testosterone levels, as well as lowered affiliated androgen levels. (Androgens are various hormones that are cousins of testosterone and abundant in men.)
Again, there have been countless studies linking low testosterone to gaining weight and obesity, as well as countless studies linking low testosterone to diabetes. This one showed that prediabetes — which is a step between weight gain and diabetes — is also associated with low testosterone. No big surprise.
(Source: Journal of Diabetes Research, Volume 2016, Article ID 1747261, 8 pages)
A published study followed 261 men who were either overweight or obese and had low testosterone. About 35 percent were overweight, and the rest were obese. Obesity is defined as having a BMI (a ratio of height to weight) greater than 30.
The men were put on long-acting testosterone, similar to the way that we do testosterone replacement therapy at Allure, and followed for five years.
In this study, all but about 4 percent of the men who were overweight or obese had meaningful weight loss at five years. It was gradual every year throughout the five years. Eighty percent of the men lost more than 10 pounds in the five year-period, 50 percent lost over 20 pounds, and 30 percent of men lost more than 30 pounds. Fourteen percent of the men lost over 40 pounds.
There have been no studies involving either drugs or lifestyle changes that had this consistent and substantial long-term weight loss results. Nothing has ever worked this well.
(Source: 2013 International Association for the Study of Obesity. Clinical Obesity 3, 73–83)
The percentage of overweight men is significant, particularly those who are middle age and beyond. And there’s a striking rise of increasing obesity.
There are three classes of obesity. A BMI 30-35 is called class I, BMI of 35-40 is class II, and a BMI of greater than 40 is class III.
In one study, they evaluated the use of long-term testosterone replacement in obese men with low testosterone. There were 411 men followed for eight years.
Of the 411 men, only four did not lose weight over the subsequent eight years. As you can probably imagine, this is generally unheard of with conventional weight loss techniques.
All the other men in the study lost weight and lost inches off their waist, with the majority losing more than six inches.
Men with class I obesity lost an average of 38 pounds. Men with class II obesity lost an average of 55 pounds, and those with class III obesity lost an average of 66 pounds.
In addition to losing weight, they saw improvements in their blood pressure, blood sugar, cardiac lipids, erectile function, and overall quality of life.
(Source: International Journal of Obesity (2016) 40, 162–170; doi:10.1038/ijo.2015.139)
To put this in perspective, let’s look at conventional ways that doctors help their patients manage weight. They can suggest weight loss programs or drug therapy.
Long-term weight maintenance is a real problem after weight-loss programs. A review of more than 50 weight-loss clinical studies with over 2,000 people showed that less than 25 percent of people maintain significant weight loss after substantial lifestyle intervention. And then at five years, after an intentional diet and lifestyle change, the average individual only lost about six pounds.
(Source: American Journal of Clinical Nutrition 2001; 74:579–84. Printed in USA. © 2001 American Society for Clinical Nutrition)
Weight Watchers, which is known to be the most successful long-term weight loss program in the United States, conducted a study of 699 lifetime members and their relative success at weight loss over five years. The percentage of Weight Watchers lifetime members who maintained at least 5 percent of their weight loss for five years was 50 percent. That’s pretty good compared to other weight loss programs and speaks to the success of adhering to a successful program.
(Source: British Journal of Nutrition 2008 April; 99(4):925-30. Epub 2007 Nov 28.)
Drugs are an option to treat obesity and, in fact, are commonly prescribed by physicians much more often than prescribing testosterone for weight loss.
But these drugs, unlike testosterone, are fraught with side effects and cannot be safely taken for a long period of time.
A review of the clinical studies for the FDA-approved weight loss drugs shows that about 50 percent of people who take these drugs lose a clinically meaningful amount of weight, which is defined as 5 percent of their body weight. This is a fraction of the results compared to testosterone replacement.
(Source: JAMA. 2014 January 1; 311(1): 74–86. doi:10.1001/jama.2013.281361)
For men with low testosterone, testosterone replacement should be considered. In my opinion, it’s more or less mandatory.
A study published in 2015 followed 83,000 men with low testosterone. Some of the men, who averaged age 66, were treated with testosterone replacement and some were not.
The men treated with testosterone replacement were half as likely to die in the subsequent six years than the men who were not treated. Those not treated were also about half as likely to have a heart attack. In other words, men with low testosterone who are not treated with testosterone replacement have about double the risk of premature death and heart attacks.
(Source: European Heart Journal (2015) 36, 2706–2715)
The bottom line: If you are obese or have concerns regarding weight gain, consider testosterone replacement therapy. There is conventional wisdom that testosterone needs to be extremely low before a man is treated, but this is nonsense. There is no predictable laboratory value that predicts which men will respond to testosterone therapy and which will not.
The reference range for testosterone levels at most clinical laboratories ranges from 250 ng/dL to 1100 ng/dL. This is very old-school thinking. To establish that reference range, they measured the testosterone level of 120 men and assumed that 95 percent are normal. This assumes that virtually all men have normal testosterone, which is not the case — it declines as we age.
In reality, men become symptomatic typically below 500 ng/dL. But most physicians do not even consider treatment unless it is below 300, or 250 ng/dL, and the patient has severe signs of testosterone deficiency such as the inability to get an erection or severely diminished energy.
There is no reason to wait until your symptoms are severe to treat something as simple as testosterone deficiency. It is not a healthy approach. Not treating low testosterone will lead to more heart attacks, more obesity, a lower quality of life and more deaths.
There are no adverse events or health risks associated with taking testosterone replacement therapy for men with low testosterone. There remains a bias with physicians to prescribe testosterone because it is commonly confused with anabolic steroids.
If you think you have low testosterone, or want to be screened for it, visit our office where you can have a blood test and fill out a questionnaire. The two can be correlated. Contact us at 586-992-8300.
Dr. Charles Mok