Episode 84: Dr. Abe Morgentaler: Testosterone
Dr. Abraham Morgentaler, M.D. is an associate clinical professor of urology at Harvard Medical school and the author of "Testosterone For Life." After 30 years conducting research on "T" (testosterone), Dr. M believes that millions of men have low T and don't know it. If you are a man, or love a man, this one episode you don't want to miss!
Men: If you are always tired, feel like you've lost your "edge", lost your enthusiasm, feel like a grumpy old man - you may be experiencing the effect of low T. Listen in as we discuss T, dispel some myths, and delve deeply into this problem that frequently just gets chalked up to "getting old." And don't miss Dr. Morgentaler's exercise for you to try at home.
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Chip August: Welcome to Sex, Love and Intimacy. I’m your host Chip August and on today’s show, we are going to be talking about testosterone and men and better sex and vitality and health. We’re going to be talking with Abraham Morgentaler. Morgentaler, is that the way you pronounce it?
Dr. Abe Morgentaler: Yes, (inaudible) Morgentaler.
Chip August: Thank you. He’s a doctor, an Associate Clinical Professor or urology at Harvard Medical School and the founder of Men’s Health Boston, a center focusing on sexual and reproductive health for men. He’s the author of a number of popular books and the book that I just read of his, and what we’ll be talking about, is titled Testosterone for Life, subtitled Recharge your Vitality, Sex Drive, Muscle Mass and Overall Health. Welcome to the show Dr. Morgentaler.
Dr. Morgentaler: Great to be with you Chip.
Chip August: Now I was telling Dr. Morgentaler off the air here that I actually read the book and thought, hey wait a minute. He’s talking about me. So let’s just start with why did you write the book?
Dr. Morgentaler: Well you know, so I’m in practice 20 years now and focus on sexual medicine and reproductive issues for men. And from the very start, I’ve been interested in testosterone work. I did some research when I was an undergraduate with (inaudible) testosterone and so I finished my training and then I got out in practice in 1988. I started measuring testosterone levels in men and found that a lot of these guys had low testosterone, especially if they had sexual symptoms like poor erections, diminished libido, changes in orgasm sensation. And as I started treating these guys, many of them, I don’t want to say all of course, but many of them came back and not only were their sexual symptoms better, but they felt better in other ways too – energy, mood, sense of vitality. Their work outs at the gym got better. They didn’t feel like they were walking through mud anymore. And the strange thing was that nobody else really seemed to be paying attention to these symptoms or to these men. And as time has gone on, I think that there’s now been a growing, increasing awareness in mainstream medicine that testosterone may be good for a number of things. But it’s still so far away from where I think it needs to be. So I wrote this book, bottom line is because there are a lot of guys who have low testosterone, they’re listening to your program or the women know that their guy has it and they’re listening to you. It’s never been diagnosed and nobody has offered them treatment. I wanted guys to know what’s out there and how to get it figured out and treated.
Chip August: Now let’s, that’s great. Let’s start with some simple building blocks here. What exactly is testosterone and people have heard the term but what is it? Could you define it and talk a little bit about testosterone and men?
Dr. Morgentaler: Right. So testosterone is a normal chemical made in the body by both men and women, but in much higher amounts in men. It helps us develop normally, look like guys as we go through puberty. And then it’s involved in a whole number of normal functions in our body, like bone, muscle, brain, sexual function, deepening of the voice, shaving, body hair, all that stuff. And as we get older, the levels tend to decline. Our production, our factory stops making quite as much. And when levels get low enough, then guys start to have symptoms.
Chip August: OK. So let’s talk about some of those symptoms because they’re not totally obvious here. I notice there are emotional symptoms. There are sort of mental acuity symptoms. There are sexual symptoms. Can you talk a little bit about some of these symptoms?
Dr. Morgentaler: Yes. I break them down into two kinds, the sexual symptoms and the non-sexual symptoms. I think in the past one of the reasons doctors were less interested in testosterone was that they really thought of it exclusively as a sexual issue. It does have important sexual effects but that’s not nearly the whole story, and the way that testosterone has now become even more mainstream is because of its non-sexual parts. But the sexual symptoms are that guys tend to have the less interest in sex. They may still have interest but the intensity of that interest is reduced or they may just not think about it that often. Sometimes (inaudible) they don’t have any interest left at all. Another one that we don’t often think about with testosterone is that erections are less good, sexual performance, so a lot of guys come into the office. They want Viagra or Cialis or Levitra, but what they really have is they have low testosterone. Testosterone is important for how the penis works with erection. The other symptoms are diminished sense of intensity with the orgasm. It doesn’t feel as amazing all the time or the guys we find that they need to concentrate or focus just to be able to get to a climax. A lot of guys have the problem of too quick ejaculation through much of their lives and they get to a certain point and they say, “This is crazy. I need to work so hard just to get to the point of coming at all.” So those tend to be the sexual symptoms.
The non-sexual ones, most common is the guys just feel like they’re less energetic. They may be falling asleep after meals. They don’t have the same get-up-and-go. There are also effects on mood in two ways. Guys may be less upbeat and they also may have more negative moods. Things like irritability, sometimes their wives or their girlfriends or people around them will say that they’ve become like a grumpy old man. As a matter of fact, one of the most common things we get from guys is we pull it all together, how they pull it all together, they say, “I feel like I got old.,” and they may be only 45 or 55 or 65, but whatever it is, it’s changed for them fairly quickly. Some of the other, go ahead.
Chip August: That was one of the things that struck me is that a lot of, as I’m reading your book, I’m thinking, “You’re describing things that I would just normally, that I have been ignoring in myself thinking this is just getting old. This is what getting old is.” And you’re basically saying, “Yeah, maybe but there are some things you can do about this to not feel old.” Is that correct?
Dr. Morgentaler: Yes, that’s right. So there’s this term out there that’s sort of anti-aging medicine. I never liked that very much and I don’t consider myself part of that field, but when people don’t have the same get-up-and-go, when they’re down, when they’re blue, when everything bothers them, when they’re achy, when they feel like taking a nap instead of doing something, often what they experience it as is I feel old. And when we can reverse that or change it, when they feel more energetic, more upbeat, when they have more zest for life, what the guys often say is, “I feel younger, younger.” Now I’m not saying we really necessarily made anybody younger. Nobody is going to live to 150 just because we find out they’ve got low testosterone. We treat them but that’s how people experience it. They feel more alive and more vigorous.
Chip August: Right. It’s sort of you feel rejuvenated and it’s not really about your longevity. It’s just about that feeling of zest for life and yes, that feeling of being younger.
Dr. Morgentaler: Yes. You know, there is a, the, I had a guy in the office earlier today who has got low testosterone and what he noticed is he’s in his early fifties, 51 I think, and he still plays soccer on a regular basis, once a week, on the weekends with a group I guess. He’s played for a long time. And what he notices is that his exercise capability is reduced, that it takes longer to re-charge. He’s really got to take a nap after he plays which he didn’t have to do before. Some guys will go to the gym. They realize they just can’t do more like they used to. After a while, you’ve been working out, you can increase the weights and some guys can’t do that anymore.
Chip August: Got it. Alright. Now I want to talk a lot more about this, but I also want to pause for a moment and take a break, so you’re listening to Sex, Love and Intimacy. I’m your host Chip August. I’m talking to Dr. Abraham Morgentaler. We’re talking about testosterone and some of its sexual and non-sexual effects. As we go to break listeners, I just want to remind you that my sponsors often offer pretty good deals for listeners of my show so for instance, AdamandEve.com is offering up to 50% off on about 18,000 different toys and products and DVDs that might enhance your sexuality. Audible.com is offering I think 20% off on their line of books and all kinds of listening materials. It’s just all kinds of deals so please listen to the messages and support these sponsors because they help me keep the show going and you also might want to take a look on my episode page at PersonalLifeMedia.com and take a look at some of the deals there. As I say, we’re going to pause. We’ll be right back.
Chip August: Welcome back to Sex, Love and Intimacy. I’m your host Chip August. I’m talking to Dr. Abraham Morgentaler and we’re talking about testosterone. He wrote a wonderful book called Testosterone for Life. Before we took the break you were talking about some of the sexual and non-sexual symptoms of low T. Low T, low testosterone. It’s testosterone. It’s easier to say low T so I’m going to say that. Are there any medical risks to having low T?
Dr. Morgentaler: Well there are and it’s really interesting. I think this is what’s bringing testosterone into, this is why medicine is getting more and more interested in testosterone. So listen to this. It’s really rather remarkable. So number one, testosterone we’ve known for some time is important for bones, for bone health. It turns out that men with low testosterone are at a higher risk of osteoporosis. It’s not just women who get it. It’s men, men who have low testosterone. If you have osteoporosis it means that a minor, relatively minor trauma can cause broken hips, broken bones. That’s serious stuff. So that’s number one. Number two is we find low testosterone very commonly in association with a couple of the most common medical conditions - men with diabetes. In some studies, up to 50%; in others 40% of men who have diabetes have low testosterone. Similar numbers for men with obesity which are two of the most common conditions we have in this country.
Chip August: Now just to be clear, do we know whether the diabetes causes the low T or the low T causes, or do we just notice these two things happen in concert?
Dr. Morgentaler: Well we’re starting to. So the diabetes story gets even more interesting. So listen to this. There are a number of studies that are called longitudinal studies where they bring in men or women, but we’re talking about guys today, and usually thousands of them or many hundreds. They get their health history. They draw their blood and then they follow them for years and the see what happens to them. It turns out that men, this has been done in several studies now, that men who are followed for seven to 11 years who are on the lowest 25% of testosterone levels have double the risk of developing diabetes.
Chip August: Wow.
Dr. Morgentaler: So even if they don’t have symptoms, just being in the lowest corridor of men who are sampled, adult men, meant that they’re at a higher risk of getting this problem. So it’s common in diabetics and even if you don’t have diabetes, if you have low testosterone, you have a higher risk of getting it. The other thing you have a higher risk of getting is something called the metabolic syndrome which is a collection of signs and symptoms that goes along with cardiovascular risk factors. So there is something really interesting going on that way. A couple of small studies have shown that men with diabetes who are treated with testosterone ended up with lower blood sugar and better function of insulin which is the hormone that helps the body actually use blood sugar. Very, very interesting story that’s still being played out, hot area of interest.
Chip August: Now you also said it’s related to obesity. I know at 56 years old, I’m carrying probably 40 pounds that is really hard to let go of. So what’s the relationship with obesity?
Dr. Morgentaler: There are a couple of things. One is that fatty tissue actually takes testosterone and converts some of it into estrogen which we think of as a female hormone but guys have it too, just like women have some levels of testosterone. The more fatty tissue means that we’re using up some of the testosterone we have into estrogen which doesn’t do as much good for us. But listen to this. When the guys come into my office and we diagnose them with low testosterone, because of the association with osteoporosis, we routinely will do a bone density test called DEXA, dual energy x-ray absorption. And our machine is a little fancy. We also can measure how much muscle and fat they have on their body. It’s called body composition. Much more sophisticated than what guys use at the gym and things like that. We do that at the beginning and then three months after we’ve treated these men to normalize their testosterone, we will repeat the body composition. Almost without exception, the men will add several pounds of muscle and lose several pounds of fat.
Chip August: Wow.
Dr. Morgentaler: It’s a remarkable thing. Testosterone has regulatory effects on our muscle and on our fat.
Chip August: Wow. OK. So are most doctors, if I just go in for my regular physical, would a doctor even know to test me for this?
Dr. Morgentaler: He may or he may not. I would say that three years ago, probably nobody would or it would be pretty rare if they did. But primary care is now getting interested but it still doesn’t mean it has gotten there, and frankly, that’s why I wrote the book is because there’s so much, there’s a huge gap out there between all the men who have this condition really are not living as full a life as they think they should or as they could, and the treatment that they’re getting or rather not getting. And I’ll tell you, this year, I do a lot of lecturing at medical meetings and stuff, and this year I gave a talk at one of the big primary care meetings as I’ve done in years past on testosterone, and for the first time this year, I felt like a rock star when I came off the stage because I was surrounded by doctors who had all these questions about testosterone. That was really cool and what it means is that there’s new interest in this and I think it’s coming.
Chip August: This is really good. Now you talk about low T and then you also talk about something called free T. Can you tell me what those are and what the differences and why they’re both important?
Dr. Morgentaler: Right. So if a man is listening to this show or if a woman is and she thinks that maybe the man in her life may have some of these symptoms, then the next step is to go to the doctor and ask for two tests. One is called total testosterone. The other is called free testosterone. It’s not called free because it doesn’t cost anything. It’s called free because most of the testosterone in our bloodstream is attached to these carrier molecules, proteins, but a small percentage, 1% or 2%, is unattached to anything and we call that free testosterone. It turns out that free testosterone tends to be a more reliable indicator of the status of testosterone for the men than the total amount because the total measures some of it that’s bound so tightly to these carrier molecules that the cells in the body can’t really use it. But we use both. It’s important to get both tests. If either one of them is low or lowish and the man has symptoms, then I think it’s very reasonable for him to have a trial of therapy.
Chip August: And these tests, this is just a blood test right?
Dr. Morgentaler: Just a blood test. Now it’s important for your listeners to realize though that if they’ve gone in for their regular physical once a year or something, it would be highly unlikely that anybody checked the testosterone level on them. It’s not part of the routine tests that are done. So the doctor has to have a reason to check it or there’s nothing wrong with being the squeaky wheel to get the grease. Ask your doctor to check it for you.
Chip August: OK. Now let’s say you do, you have the symptoms. You get the test. There’s, your doctor agrees, “Alright. Maybe some T therapy would be good for you.” What is T therapy? What do they do? How do they help you?
Dr. Morgentaler: So the goal is to raise testosterone levels back to where guys had it probably 10, 15 years before now, in many cases, back into youthful levels of men in their twenties and thirties. We’re not trying to get above the normal range. We’re not trying to create these body builders. The bodies of some of these (inaudible) have given testosterone and other things a bad name. And the treatment comes in several forms. Unfortunately in the United States, we do not have an effective safe pill yet so that’s not one of the options. The most common treatment that we use is a gel that you rub in your skin once a day. There are a couple of FDA-approved products that are out there on the market and they’re very good. There are some patches that have been around for a while. They work. We tend to not use them as much as the gels because they don’t absorb as well and they can cause some skin irritation but they’re available. Injections of testosterone into the bum, the buttock area, are still a very common treatment, probably the least expensive of what we have because it’s been around for so long. Most men get an injection every two weeks or so. Some of our patients, we actually teach them to do it themselves or their wives will do it for them and no, they don’t need to come into the office.
Chip August: It reminds me when I was, when my wife and I were trying to get pregnant, we had fertility issues. I had to learn to give her injections and yes, it’s not hard to learn.
Dr. Morgentaler: It’s not hard. It’s a freaky idea at the beginning but it’s really simple.
Chip August: Yes.
Dr. Morgentaler: And then the last way we give testosterone usually is a little bit new but I like it, is a little pellet that we put underneath the skin and it lasts for about three to six months and then the guy doesn’t need to think about it at all. He doesn’t have to apply a gel every day or a patch or come in for injections. So those are the ways that we do it and all of them give testosterone that is essentially the same molecule that men make normally on their own. They’re just not making enough of it.
Chip August: This is all great. I want to take a short break. When we come back, I want to talk a little bit about testosterone and prostate cancer because you have some things to say about that also, but first we’re going to take a short break, give a chance for our sponsors to support the show.
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We’re going to take a short break. When we come back, we’re going to find out a little bit more about testosterone and health and we’re going to talk a little bit about things you can do to make sure that you’re okay. But first, let’s take a break.
Chip August: Welcome back to Sex, Love and Intimacy. I’m your host Chip August. I’m talking to Dr. Abraham Morgentaler. He is the author of Testosterone for Life. We’ve been talking about low T and some of the symptoms and some of the treatments, and when we went to break, I was saying I’d kind of like to know a little bit more about the link between low testosterone and/or prostate cancer. Can you talk about that a little bit?
Dr. Morgentaler: Yes. That’s an important topic because until really quite recently, I think the number one concern that doctors had about giving testosterone was the fear that maybe it might wake up some sleeping prostate cancer somewhere. I’m pleased to report that the data that are coming out over the last couple of years have really been very clear and very reassuring. There is no evidence at this point that testosterone increases prostate cancer risk, that it makes prostate cancer grow, that men who get testosterone are at any higher risk of anything with that. I’ve actually, it’s an area that I’ve done a lot of my own research with and have published quite a number of articles in the medical literature. And where it comes from is the idea that men who have prostate cancer, that it’s advanced, from decades now have had their testosterone levels lowered and at least temporarily that helps the prostate cancer shrink and go away. And so people have assumed that raising it is going to make it grow and grow. But in fact, the prostate tumors can only handle, they can only use a little bit of testosterone. And when somebody has a little bit, then adding more doesn’t seem to do anything bad to the prostate. So that’s why adding testosterone to men doesn’t seem to be a problem at all.
Chip August: Now as long as we’re on the subject of sort of what’s good and bad about it, let me just run some myths by you here. So if I, I’m rubbing the T gel on me, am I suddenly going to have to shave twice a day? Am I going to grow hair like the Wolfman?
Dr. Morgentaler: Well those are good questions because that’s the stuff people worry about. So the answer is no. We’re just getting people back to where they used to be in terms of their hormone levels. Now some people will have noticed over the years their beard may not be as thick, that they don’t have to shave quite as often and they have lost a little bit of their body hair or hair on their legs, for example. And some of those men, if their testosterone is restored to normal levels will come back to where they were. But no, the guys aren’t going to get hair on their palms and have to shave twice a day.
Chip August: OK. Now let’s look at the other side of that. Is it going to increase my likelihood of male pattern baldness?
Dr. Morgentaler: Great question. The answer is no it won’t. And the reason people ask about that or why you may be is because there is an androgen or sort of testosterone-related relationship between that. In other words, if men who are, there are old experiments that men who are castrated early in life, for example, first their singing ability in the 1700s and things like that, that they never lost their hair. So as it turns out, some male pattern baldness is related. You do need to have some testosterone running around your system, but almost everybody listening to this program has more than enough testosterone already, even if it’s low, to do whatever it’s going to do for the baldness and adding more doesn’t make a difference. Most baldness in men is genetically related.
Chip August: OK. So just a couple more of these. So I know that steroid abusers, people who are really doing this as weight lifters or their trying to cheat in sports, report like their testicles shrink and they have difficulty getting erections. Is that, is there any likelihood that this is going to affect the shape of my testicles or my scrotum or any of that kind of stuff?
Dr. Morgentaler: It’s really important for us to make a distinction between what body builders do and the medical use of testosterone. So body builders not only are aiming for levels that are sometimes 20 to 50 times normal, they also almost always use multiple agents, some of which were never intended for human use. A lot of body builders know that the stuff is veterinary, intended for veterinary use--
Chip August: Oh my goodness.
Dr. Morgentaler: -- cattle and horses, some stuff we really don’t know about. In humans with normalizing testosterone, it does not cause trouble with erections at all. As a matter of fact, it’s one of the best treatments we have for men with ED. And there are rare cases where men will notice that the testicles are not quite as firm as they used to be, pretty unusual for them to shrink much in size. Again, not commonly seen and the effect is really minor.
Chip August: Well thank goodness for all of that.
Dr. Morgentaler: Absolutely. Otherwise, no, listen, if that stuff were really true on a common basis, nobody would use it.
Chip August: Yes. Yes. Now there is a little bit of this that, I have a good friend who’s actually doing T therapy, and he claims, it actually even helps literally his mental acuity, that he just feels sharper.
Dr. Morgentaler: Yes.
Chip August: Yes?
Dr. Morgentaler: We have, it helps with what we call brain fog. Guys feel sharper. Two years ago I did a, on Father’s Day I did a radio show with Shawn (sp.) McHeal (sp.) who’s a professional golfer who won one of the big tournaments a few years ago. And after the (inaudible) tournament a year or two later, he just didn’t feel right. He was standing on the practice green and putting. He just didn’t feel sharp. He felt like he had a fog in his brain. And they diagnosed him with low testosterone. They treated him and he felt himself again. So that many of us, even if we’re not professional golfers, we want to be at the top of our game at work, in life, enjoying life, and if our testosterone level, which is a normal male hormone isn’t normal, if we have a deficiency of it, then it affects us and normalizing it often makes people feel brighter and sharper.
Chip August: So I loved the book. I was fascinated by the whole thing. If people want to know more about this or they want to get the book or they want to get in touch with you or your clinic, how do they find you?
Dr. Morgentaler: Well the easiest is to give the website for the book which is testosteroneforlife.com. It’s also on Amazon.com and hopefully in most bookstores near you. I also have, if you like my approach to some of this, I write a blog on Psychology Today online so if you go to psychologytodayonline.com or I think it’s psychologytoday.com, if you go to the blogs you’ll find my name in there. I think the title of the blog is Men, Sex and Testosterone and it talks about testosterone as well as some of the other sexual issues.
Chip August: Terrific. I will also include a link to the blog and also to Testosteroneforlife.com on my episode page. So listeners you can always just go to the episode page and you’ll be able to link up right there. While you’re at the episode page, just if you might want to take a moment to give me some feedback, so if you want to let me know what you’re liking or not liking about the shows or you want to suggest future guests, why please, send me an email to [email protected].
We’re coming to the end of the show here. Usually I end the show with an exercise, something that people can do to improve the sex, love and intimacy in their lives. This doesn’t, this subject doesn’t really lend itself to an exercise but we talked a little bit about some advice you might have for people so what would you tell people about improving the love, intimacy and sexuality in their lives?
Dr. Morgentaler: Well this is what I deal with professionally and with regards to testosterone, the topic we’re talking about or even beyond testosterone, I think if, I like your idea of doing an exercise and here’s the exercise that I suggest to men or women who are listening in, which is this show ends. Turn off everything and take a moment and just reflect on whether you feel as alive as you think you should, whether you have all the intimacy and the sexual feeling in your life that you think you should be having on an internal basis. And if you don’t and you’re male, then there’s a chance that if you’ve lost some of that feeling, you have low testosterone. It may be worth you checking it out with your doctor, two simple blood tests to ask for. If you have that feeling that sex somehow hasn’t become the biggest part of your life or you’ve lost that, then I would suggest that you look towards way in which you may bring it back in because the evidence is quite clear from research, from personal experience as a physician with my patients that when people feel like they are engaged in sexual intimacy with partners, with other people that they feel more alive and their life is fuller, and I think that’s a worthwhile message.
Chip August: And I would add to that men, if you have a partner, if you’re not alone, if you have a partner you might actually ask your partner if they’ve noticed ways that you have changed over the last five years or so. Have they noticed that you’re grumpier? Have they noticed that you seem more moody? Have they noticed behavior changes that maybe have kind of crept up over time and they didn’t want to say anything because they thought maybe it was, maybe it’s just a part of aging and it would be great to just look in the window, look in the mirror of your partner’s perception of you. You may see a whole lot of things that you haven’t really been looking at.
Dr. Morgentaler: I think that’s a great suggestion. I think your listeners should seize the moment and do whatever they can to live a great life.
Chip August: Well Dr. M, you have been a great guest, a lot of information here. I really appreciate you taking the time to come on the show and I’ve really enjoyed talking to you.
Dr. Morgentaler: Thanks so much Chip.
Chip August: Thank you. And listeners, thank you so much for listening to the show. I really appreciate your support and I hope you’ll join us again next time for Sex, Love and Intimacy.
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