Big Bellies and Low Testosterone
Beer belly. Food baby. Whatever you want to call it, men need to know that carrying weight about their belly causes many health problems. In past blogs, we have explored sleep apnea, high blood pressure, high cholesterol and diabetes, but did you know that belly fat may also affect your testosterone?
If you stand up straight, and look down for your toes, can you see them? If not, it’s time to take out a tape measure and measure your real waist. Men can push their waistbands below their bellies, but really the true waist measurement should be taken level with the belly button. Those with a waist measurement over 42 inches are twice as likely to have erectile dysfunction, bigger prostates, and being overweight places them at risk for having low testosterone.
Testosterone is the male hormone that contributes to the deep voice, large muscles, body hair, sperm production, libido (sex drive), and normal erections. The hormone also plays a role in red cell production, boosts the mood, and helps with how the brain works or thinks. By the age of 40 the testosterone levels begin to drop by 1-2% each year. So, by the time a man is in his 50s or 60s, he may notice some changes. However, obesity speeds up this drop in the hormone.
Hypogonadism (hypo means low function, and gonadism refers to the testicles) affects 2.6 million men in the United States, and is often overlooked. Common symptoms of low testosterone include:
Decreased arousal or sexual satisfaction
Absent morning erections
Difficultly achieving or maintaining erections
Decreased sex drive (libido)
Decreased body hair
Storage of fat in the belly
Reduced body hair
Decreased muscle mass
Reduced size of the testicles
Low testosterone can also lead to thinning of the bones (osteoporosis), anemia, and infertility due to the reduced sperm count.
Who is more likely to have low testosterone? Other than normal aging (most have hypogonadism by age 80), again, those who are obese can be affected, but also those with diabetes, those who have to take corticosteroids, and even those who take anabolic steroids for bodybuilding. It is also common in those taking prescription or illicit opioids (narcotics) on a long-term basis, with this reducing the testosterone level by as much as 50 percent. The thyroid is the master gland and plays a vital role in hormones. In severe cases of thyroid disease, the testosterone may also be found to be abnormally low, and treating the thyroid disease will correct the testosterone level. Alcohol abuse is also another factor in lowering the testosterone, so moderation is key.
Explaining how obesity lowers the testosterone level is very complex. With obesity, there is a conversion of testosterone to estrogen through activity within the fat cells. This sends a signal to the part of the brain that controls hormones, and causes further reduction of testosterone production. In response, there is loss of muscle mass and storage of fat, especially within the abdomen. This vicious cycle can lead to more weight gain, more estrogen, and less testosterone. Furthermore, storage of fat around the organs within the abdomen greatly increases the risks of heart disease, diabetes, cancers and other chronic diseases.
Men with erectile dysfunction often blame a low testosterone as the cause, but some studies show that this only accounts for 3% of cases. However, if you have several of the symptoms, you should talk to your healthcare provider to see if testing the hormone level would be helpful.
Most research and specialists agree that the timing of getting the blood drawn is essential. Our bodies have a diurnal rhythm (sleep-wake cycles). The testosterone level is highest in the morning, so many suggest testing the level before 9 a.m. This is because, as we look for low testosterone, we want to know what is your best (or highest) testosterone level to determine if hypogonadism is causing your symptoms. (The only exception is those who work the night shift.) If the initial testosterone level is low, then it is usually repeated in two weeks. This is to confirm the diagnosis and prepare for treatment. The normal level is 300-1000.
Treatment of low testosterone requires some follow up. Those who are overweight need to know that if the obesity is not addressed, the hormone supplements are not as effective. Weight loss, a healthy diet and exercise are key in treating hypogonadism. In many cases, lifestyle changes such as these are just as effective as taking a supplement. As a word of warning, there are many online supplements that really are not worth your money or time. They are not regulated by the Food and Drug Administration, and really should be avoided. Testosterone is often prescribed as an injection or by topical administration, but there are also some other options. Your healthcare provider will work with you on what is best for your body.
Testosterone supplements can thicken the blood, which can place you at risk for a heart attack, stroke or blood clot. Therefore, in addition to checking the hormone level, other lab work will be monitored. This often includes a PSA, lipids (cholesterol), hematocrit, and possibly other tests depending on which form of supplementation is used. You will also need to see the healthcare provider for an annual exam of the prostate. Although not clearly understood, there is some thought that the supplement could stimulate abnormal cells in the prostate, and early detection of prostate cancer or benign prostatic hyperplasia is key.
Who is not a candidate for testosterone? Those with previous breast (yes men can have this) or prostate cancer, untreated sleep apnea, severe urinary tract symptoms and those with a history of heart failure are not candidates in most cases.
The benefits of supplementation are reported to be good. There is often a sense of well-being, better sex life, improved lipids, better blood sugar, and less belly fat including those who have obesity, metabolic syndrome and type 2 diabetes. Remember: to maximize the response to therapy, exercise and get down to a healthy weight. It’s about quality of life and longevity.
**If you have these concerns, make an appointment with your healthcare provider.