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Healthy Men: Think before you reach for that testosterone

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Dear Healthy Men: My teenage boy isn’t maturing as quickly as his peers. His voice has barely changed, he’s hardly got any facial or body hair, and at 14, he’s one of the shortest boys in his class (my wife and I are both above average in height). He’s also tired a lot of the time and is more than a little pudgy. Lately he’s become obsessed with the idea that his problem is low testosterone. He’s constantly forwarding me YouTube videos and screenshots internet ads and is trying to convince me that he needs testosterone supplements. Could he be right? I thought low testosterone was only something that affects older men.

A: The answer to your question is yes and no. Yes, he could indeed have low testosterone (frequently referred to as Low-T). But no (no, no, no), he should absolutely not start taking supplements or doing anything to “treat” the problem until he’s been properly diagnosed by a professional. And by professional, I mean a trained health care provider who will run the proper clinical tests to measure testosterone levels and other biomarkers, who’s committed to identifying the underlying issues and how to overcome them rather than to selling you a bunch of pills or other treatments. Stay far, far away from anyone (including advice columnists) who claims to be able to diagnose and treat low testosterone or other medical conditions without actually having some actual contact (in person or, in some cases, virtually) with the patient.

Testosterone is a naturally occurring hormone that in boys helps regulate many of the markers of sexual maturity, including hair growth, muscle mass and voice changes. (Girls also produce testosterone and it influences their sexual maturity as well, but to a far lesser extent.) Testosterone also plays a role in mood, fat distribution and energy levels.

The symptoms you’ve described may or may not be caused by low testosterone. For example, several studies have found that testosterone levels in obese teenage boys are half of what they are in normal-weight boys. But is obesity causing the low testosterone or is it the other way ’round?

As far as your son’s energy levels, if he’s got a weight problem, chances are he’s not getting enough exercise. Lack of exercise contributes to lack of energy. But low energy can have many other causes, including vitamin D deficiency. Body hair, height and voice changes? Could be testosterone—or it could be that your son is just maturing slowly. Puberty is hitting kids at younger ages these days, but not everyone is fully mature by 14.

If it turns out that your son’s testosterone is low, the biggest concern is to find out why. In boys, testosterone is produced in the testicles (hence the similar names), and an abnormality could affect levels. A number of genetic conditions and prescription medications can lower testosterone. And then there’s antibacterial soap. Yep, soap.

In 2016, the Food and Drug Administration banned an antibacterial/antimicrobial chemical called triclosan, which, according to Dr. Stephen Giorgianni, an adviser to Mens Health Network, a Washington, D.C.-based nonprofit, was an ingredient in a wide variety of personal care products, including soap, shampoo, dishwashing liquids, deodorants and even some toothpastes.

“The problem with triclosan is that, chemically, it looks like testosterone and functions as a sort of Trojan horse,” says Giorgianni. “When the faux-testosterone gets into the bloodstream, our body thinks it’s the real thing and stops producing natural testosterone. As a result, the boy or man can develop a true decline in testosterone levels and start showing symptoms.”

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