The director of the Men’s Health Program at Mount Sinai Medical Center, Tamler is an endocrinologist who specializes in treating men with low testosterone, erectile dysfunction, osteoporosis and diabetes.
WHO’S AT RISK
Low testosterone is a problem for about 15 million American men, most of whom remain undiagnosed and untreated. “Testosterone is the main male hormone,” says Tamler. “It’s what makes guys guys and drives sexual desire, but it also has other health functions, like protecting against osteoporosis and preserving lean body mass. And low testosterone is highly predictive of future heart disease and diabetes.”
Testosterone levels go down naturally as men age. Men over the age of 45 are considered at especially high risk of having low testosterone — also called hypogonadism — if they are obese or have sleep apnea, heart disease or diabetes. These conditions can cause low testosterone, or they can be caused by low testosterone. “It’s a chicken-or-the-egg thing,” says Tamler.
Other risk factors include chronic kidney or liver disease, HIV, certain medications and excessive alcohol intake. “Men who experience trouble with fertility should be tested, as should men who get a fracture, especially an unexplained one,” says Tamler. “Hypogonadism is a big risk factor for osteoporosis in men.”
Low testosterone is an increasingly common problem, in part due to rising rates of obesity in this country. “Fat mass turns male hormones into female hormones, hence the breast enlargement experienced by obese men,” says Tamler.
SIGNS AND SYMPTOMS
The classic symptoms of hypogonadism are decreased libido, erectile dysfunction, fatigue, loss of muscle mass and depression. “So many men have come to me not because of erectile dysfunction, but because they’re feeling low energy,” says Tamler. “Their significant others say, ‘This has been going on too long,’ and chase them into my office.”
Other warning signs of low testosterone include brittle bones and poor focus. “Many patients report that they feel like they have brain fog,” says Tamler. “Often, that fog lifts once I treat them.”
Studies have shown that sex steroids have a cognitive effect on the brain. “If you feel low-energy all the time, it’s going to be difficult to do well on the job,” notes Tamler.
Now that doctors know that lower testosterone is predictive of higher mortality, it’s all the more important to seek out treatment.
“Mount Sinai now offers a comprehensive network of health professionals who are interested in men’s health,” says Tamler. “As an endocrinologist, I screen the patient for depression and heart disease and send him to the urologist, or the sleep lab for sleep apnea. Similarly, my counterparts know to screen for low testosterone when they are seeing their patients.”
Mount Sinai doctors plan the treatment for low testosterone to fit the individual patient. “Often there’s an underlying disease that causes the low testosterone. Anyone can paint over it and prescribe testosterone, but with our comprehensive approach at Mount Sinai, we can solve the underlying problem and bring up testosterone levels naturally,” says Tamler, who is also a nutrition-support physician. For instance, losing weight often causes levels to bounce back, and a recent Mount Sinai study showed dramatic effects after weight-loss surgery.
For patients who can’t manage their low testosterone in other ways, there is testosterone replacement. “Testosterone treatment is either a gel that needs to be applied daily, a patch or an injection,” says Tamler. “Injections are every two weeks, and there is also a long-term pellet injection that lasts for four to six months.” Oral replacement isn’t currently available in this country.
Testosterone replacement can have dramatic benefits. “My patients report that libido and energy come back, and they can build more muscle mass. It can be transformative, not just for a patient’s sex life, but for his relationship and overall well-being,” says Tamler.
In recent years, studies have established that men with low testosterone have a much higher risk of diabetes, heart disease and early mortality. “Erectile dysfunction, especially in young men, can be the earliest warning sign for blood-vessel changes throughout the entire body and for future heart disease,” says Tamler. “Men wheeled into the ER with their first heart attack will report onset of erectile dysfunction years earlier.”
QUESTIONS FOR YOUR DOCTOR
If you are feeling low desire and fatigue, ask, “Could I have low testosterone?” Another good question is, “Could low testosterone be contributing to my diabetes?” If you have low testosterone, the symptoms you chalk up to normal aging may be far more treatable than you imagine. “Treatment can bring huge benefits and relief,” says Tamler.
WHAT YOU CAN DO
Get screened. Men who feel fatigue and low desire, have erectile dysfunction or suspect they have low testosterone should be screened with a morning blood draw. “It has to be between 8 and 10 in the morning, the peak of testosterone levels,” says Tamler. For a screening, contact Mount Sinai’s Men’s Health Program at (212) 241-GUYS.
Keep a healthy lifestyle. Work to keep a normal weight and healthy activity level. “What’s good for the heart is good for your sexual activity,” says Tamler.
Pay attention to fractures. A fracture out of nowhere can be a sign of osteoporosis, which can be the result of low testosterone.