The Testosterone Epidemic: Why Has the Demand for the Hormone Grown?  

The indiscriminate and increasing use of testosterone is of concern to the medical community. Multiple risks can arise from the misuse of testosterone, from stroke and heart problems to worsening behavior and psychological disorders.

Experts note that in recent years there has been an exponential increase in testosterone use, both prescribed and illegally. According to the American, Brazilian and European societies of endocrinology, there has been a more than 200% increase in testosterone prescriptions in 10 years. The expectation of the person seeking the male hormone is to have improved libido, ambition, and vitality, as well as decreased body fat and increased muscle mass. What few know is that the benefits of hormone therapy tend to occur only in those who actually have low testosterone levels, to begin with.

Both the excessive demand and the significant increase in testosterone prescriptions by physicians have become a matter of concern for the medical community, whether in fact these drugs would be used when necessary, that is with a proven hormone deficiency, whether recreational use and aesthetics were responsible for these increases. Men who are most likely to have low testosterone are those who are obese, or over 50 to 60 years old, or previously used anabolic steroids.

Indiscriminate use of testosterone and its derivatives, especially when used above normal levels in men, can cause stroke, heart attack, thrombosis – especially if they have blood thickening, a consequence almost always present with the use of testosterone, spread of prostate cancer and various behavioral problems such as irritability, physical violence and sexual promiscuity. “That’s why every patient needs to be evaluated. Because if testosterone levels are normal, the man would not have the promised benefits,” warns Flávio Cadegiani, Endocrinologist, Master and Doctor (PhD) in Clinical Endocrinology by Unifesp / EPM.

For the Endocrinologist Flávio Cadegiani, there are eight major reasons that can explain the rapid increase in hormone use. 

Doctor Endocrinologist Flavio Cadegiani

A more accurate diagnosis – “Much of the rise in the testosterone prescription was due to both the exponential increase in the number of testosterone tests requested and the increased suspicion by physicians that certain symptoms, even if not typical, could be caused by low testosterone. In the past, patients with low testosterone were treated in psychiatry because they did not have the correct diagnosis,” says Cadegiani. 

The obesity epidemic – According to the doctor, the growing epidemic of obesity has boosted the prevalence of low testosterone levels. Anywhere from 30% to 90% of obese men may have hypogonadism, which is the name given to low testosterone in men, depending on Body Mass Index (BMI). “The more obese, the greater the chance of having low testosterone, and often the drop in testosterone leads to additional weight gain, leading to a vicious cycle, an endless snowball,” he explains.

The aging population – Men’s aging leads to reduced testosterone production as an expected effect of aging. But unlike in the past, older people now demand a better quality of life, performance, independence, cognitive activity, and most of all, to enjoy this phase of their life. “Older people have a high prevalence of low testosterone, and often can benefit from using it,” he explains. 

Endocrine disrupters – Endocrine disruptors are all substances in the environment, from plastic for storing food, pesticides, pollution, and even soaps, which compromise hormone production or testicular formation. As exposure to literally thousands of endocrine disrupters has intensified, younger generations have experienced precipitous drops in testosterone and fertility levels. Today the average testosterone of men in their 20s is lower than that of men in their 50s, due to the difference in generations. “That is, low testosterone is not unique to those who are overweight or older, but in much of today’s young men. To make matters worse, if testosterone is used in this population, their fertility drops further,” says Cadegiani.

Undoing the stigma – In the past, there was a taboo with testosterone use, even when formally administered, because of alleged risks of prostate cancer and cardiovascular disease. Today, however, it is well established that testosterone use does not cause cancer and when correctly administered may in some cases even reduce the risk of a heart attack. 

Prescriptions for those who need it – Doctors have always been afraid to prescribe testosterone, even for those who should use it, because of the supposed risks. In the past, most patients with hypogonadism and no contraindications to testosterone use received no treatment because of comfort, unreasonable thinking, and a mutual practice among physicians that it is better not to treat (or rather neglect) a patient with low testosterone than prescribing it.

Today, due to the widespread debunking of the myths surrounding testosterone, and knowing that the benefits far outweigh the risks, when properly indicated, patients who need testosterone are now properly prescribed. And not prescribing in these cases can be considered medical malpractice.

Quality of life – Cadegiani reports that, during consultations, as patients requested, the quality of life issue has been increasingly taken into consideration. “Today, if a patient has low testosterone and clinical symptoms such as depressed mood and low energy levels (symptoms that are more specific to indicate low testosterone than sexual desire itself), we would not hesitate to prescribe testosterone if there are no contraindications. Until recently we had prescribed testosterone only in the worst-case scenario.

The quest for youthfulness – “We are not yet able to healthily deal with aging.” With this statement, the doctor refers to the false promise that testosterone use will guarantee them youthful performance for the rest of their life. The search for a replacement in order to control libido may also come into this motive. “Both are misleading and deleterious promises,” reports the doctor.

Finally, the Endocrinologist explains that sexual desire goes far beyond testosterone levels. These days, stress and tiredness are far more responsible for the drop in libido than the hormone levels themselves. “A simple question can lead to a reflection on whether or not testosterone is needed. Just ask yourself, if you are traveling alone with your partner to a quiet place, and without having any day to day worries on your mind, if by chance the libido does not improve then it is very likely to be low testosterone as the culprit. If it gets better, the answer to the lack of libido was stress and daily routine,” contextualizes Cadegiani.

Testosterone, great for those who need it, harmful for those who don’t.

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