Youth in a Bottle: synthetic testosterone is the latest fad for men who refuse to grow old
Drug companies say synthetic testosterone gives you energy, helps you lose weight and boosts your sex drive. It’s the biggest thing to happen to male vanity since Viagra
Gary Rodger resembles the actor John Goodman—he’s voluble, heavy-set, quick to grin and has a head of thick, brown hair. At age 50, he lives in Hamilton and works at a company that supplies services and equipment to the telecom industry.
Three years ago, Rodger started noticing that he was fatigued all the time. His joints hurt, he was moderately depressed, his weight had risen to over 300 pounds, and his sex life with his wife was badly faltering. He began to see a relationship counsellor, who, after treating him for several sessions, suggested that his condition might be caused by low levels of testosterone in his system.
Rodger visited his GP, who administered a blood test for testosterone. Whereas a healthy patient will have anywhere between eight and 38 nanomoles of testosterone per litre of blood, Rodger scored 7.5, a level so close to the normal range that his doctor told him he was fine. When Rodger insisted that he see a specialist, he was referred to a urologist, who conducted a blood test as well. Rodger again scored 7.5, and was again told to go home.
Though his symptoms persisted, Rodger forgot about testosterone until one afternoon a few months later. After a game of golf, he started chatting with another player in the clubhouse. The topic of health came up, and Rodger found himself describing his symptoms to this relative stranger. (“We’re older guys,” Rodger says. “We weren’t talking about chasing broads, you know?”) The other golfer told Rodger he’d suffered from exactly the same symptoms and that he too had been unable to get relief until he found someone willing to prescribe testosterone supplements. That someone was Larry Komer, a heavy-lidded, somewhat taciturn 69-year-old obstetrician-gynecologist from Burlington, who also happens to be one of the team doctors for the Toronto Rock. In concert with his OB/GYN practice, Komer runs an operation called the Masters Men’s Clinic, where he treats men for a syndrome variously known as testosterone deficiency, hypogonadism, andropause, male menopause and, perhaps most commonly, low T.
Owing to Komer’s exhausting schedule—he often sees patients during the day after delivering a baby in the middle of the night—Rodger had to wait six months and only got an appointment when another patient cancelled. He took the blood test again and again scored 7.5. This time, however, Rodger was also given a lengthy questionnaire about the aspects of health most commonly impaired by low testosterone, namely energy level, libido, mood, weight and flexibility. Upon considering Rodger’s answers and his low-normal scores, Komer concluded that Rodger really was suffering from a testosterone deficiency and prescribed a testosterone replacement.
Rodger had several products to choose from. Synthetic testosterone pills are the easiest to take, though the level of absorption is low. Patches have mostly fallen out of favour, as a rash tends to form in the contact area. Injections are the cheapest and most effective, though some men feel squeamish about getting a shot in a roll of belly fat every week or two. Gels are as effective as injections but messy and expensive—a month’s supply will cost between $120 and $240, while injections average $25. On a more precarious note, gels can cause hair growth and voice deepening if they accidentally come in contact with a woman’s skin, and can spur sexual development in young children; Abbott Laboratories, the makers of the market-leading AndroGel, advise that after applying the product, users wash their hands, their sink and, just to be prudent, their faucet.
Undeterred, Gary Rodger chose AndroGel. The morning after picking up his prescription, he rubbed two dabs into each forearm and one into each of his biceps. The next day, after showering, he did so again. After three months, Rodger’s testosterone levels hit 16, and Komer upped his dosage. After six months, his levels had risen to 23, and he was starting to feel a little better. After nine months, he was at 35, or high-normal. “I felt fantastic,” he told me. “There’s no other word for it. Before, I was spending all my spare time lying on my couch eating potato chips, and suddenly I was up and doing things!”
He started going to the gym and seeing friends. He even credits AndroGel with resolving his marital difficulties, though not in the way he thought it would: “Before, I had no libido, and so I never went near my wife. When my sex drive came back, I could see my health wasn’t the issue and that we had fundamental relationship problems.” Rodger and his wife separated, he lost 60 pounds, and he moved into a new house, all of which he credits to the vitality gained from AndroGel.
Listening to Rodger’s story, it’s easy to imagine a world of hormonally deficient men all storming back to life thanks to testosterone replacement therapy. Both Mount Sinai and the executive health clinic Medcan now offer programs for the treatment of low T, as do a handful of smaller clinics—the Masters Men’s Clinic alone has seen about 3,500 men since Komer started treating low T a dozen years ago. In Canada, Eli Lilly is now producing an underarm supplement called Axiron, and Trimel will soon release a gel taken nasally. (Both, say the makers, reduce the risk of cross-contamination.) The Internet is awash with for-purchase supplements, the ingredients ranging from the federally approved to the foolhardy. Not to be outdone, American television channels and websites catering to male interests are now home to ads promoting a life free from testosterone diminishment, the visual content repeated across brands: that virile 55-year-old riding a mountain bike, his beautiful (and suggestively grinning) wife in tow.
IMS Health, a data provider for doctors and medical researchers, reports that testosterone supplementation has grown into a $2-billion-a-year global industry, a figure that doesn’t factor in the shadowy world of direct-to-consumer marketing. While this is a piddling number compared to, say, pharmaceuticals treating high cholesterol or erectile dysfunction—two other albatrosses of the fading male—it’s the trajectory that’s most compelling. In the past five years, Canadian sales have risen by a formidable 47 per cent. If this continues, soon enough AndroGel will be as common in medicine cabinets as Lipitor and Viagra.
It’s an evolutionary truism that Mother Nature is far from kind when she decides our reproductive years are behind us. We tire faster, we ache more, we laugh less. One particularly gratuitous symptom of low testosterone is loss of height; we literally shrink in the face of aging. At the same time, many of us stay in the workforce longer and aren’t allowed to weaken, or not without a feeling of under-accomplishment.
The use of testosterone supplements to fight aging dates back to 1889, when the French physiologist Charles-Édouard Brown-Séquard told the Société de Biologie in Paris that he had injected himself with a liquid extract derived from the testicles of dogs and guinea pigs. The results, he claimed, were impressive. The injections increased his energy, sharpened his mind and relieved his constipation. He also said that they lengthened the arc of his urine, a middling benefit if ever there was one.
While Brown-Séquard’s research illustrated little more than the placebo effect, he nonetheless popularized the notion that a magical secretion coursed through the testicles and that this secretion—which would later be dubbed testosterone—could put a spring in a man’s step. Thus began the era of gonadal transplantation. In 1920, a French doctor named Serge Voronoff started transplanting tissue from chimpanzee testicles into the testicles of human patients who wished to improve their sex drive and memory, and extend their lifespan. In the early ’20s, an American doctor with dubious credentials named John Romulus Brinkley began sewing slivers of billy-goat testicle into the scrotums of men suffering from impotence. This surgery, which he called “the compound operation,” made him millions, or at least it did until the American Medical Association and the Internal Revenue Service joined forces to shut him down.
More legitimate was the work of a professor at the University of Chicago named Fred Koch. In 1926, Koch harvested 18 kilos of bull testes from the Chicago stockyards. From these, he managed to isolate just 20 milligrams of what he referred to as “testicular extract.” He then injected this potion into a capon. Lo and behold, the bird began to exhibit masculine traits, which Koch correctly credited to the testosterone in his extract.
In 1935, two groups of researchers working in different parts of Europe simultaneously produced the first synthetic testosterone. With time, pharmaceutical companies turned these into marketable products and, for a brief period, doctors began prescribing synthetic testosterone to men suffering from deficiencies. This practice came to a halt in 1941, when a pair of researchers named Charles Huggins and Clarence Hodges showed that testosterone accelerated the growth of prostate cancer. While the pair were landmark thinkers—Huggins later won a Nobel Prize for his work on hormones—they concluded, perhaps a little too rashly, that high levels of testosterone must also cause prostate cancer.
For decades, the only men who took testosterone were bodybuilders purchasing from dodgy suppliers, their inventory stored in sweaty gym lockers. GPs, meanwhile, treated testosterone supplements as pharmaceutical pariahs, a perspective that didn’t start to change until a professor at the Harvard Medical School named Abraham Morgentaler (the son of the Canadian abortion rights activist Henry Morgentaler) started publishing his work. The younger Morgentaler spent the better part of the 2000s insisting that testosterone does not cause prostate cancer. He also claimed that low levels of testosterone caused an increased incidence of cancer, stroke and numerous other health problems, foremost among them a tendency toward depression, weaker erections and falling asleep after dinner. In 2008, Morgentaler published a book entitled Testosterone for Life. The cover, true to form, showed an athletic, middle-aged man wearing a bicycle helmet, his arm wrapped around an exuberantly grinning woman.
“For almost 50 years,” says Dean Elterman, a urologist who treats low testosterone at Toronto Western, “it was dogma that testosterone enhanced the growth of prostate cancer. And then Morgentaler came along and showed that it doesn’t. People said he was misguided. People called him a heretic. But you couldn’t ignore his findings.” Keith Jarvi, a seasoned urologist at Mount Sinai who heads up the men’s health centre there, put it to me more simply. “The notion that testosterone causes prostate cancer has by and large been disproven,” he said.
Other health concerns, however, linger. Users of testosterone supplements can develop acne and bruising. In some men, supplements cause an increase in the number of red blood cells; this can result in strokes and is the reason men on testosterone supplements have regular blood tests. Last February, five men in the U.S. who had experienced heart attacks or strokes while taking AndroGel filed suits against Abbott Laboratories and the Abbott spinoff company AbbVie, accusing the firms of downplaying the risks. (The companies deny responsibility.) A new U.S. study of more than 50,000 men on testosterone supplements found that the risk of heart attacks doubled for men over 65 and younger men with a history of heart disease.
Then there’s the stigma. I talked to six men who were taking testosterone supplements, and only Gary Rodger allowed me to use his name. “I’m not embarrassed to be using testosterone,” I was told more than once. “It’s just that, well, you know.…” The other refrain I heard from the six users—beyond how good they now felt—was the reluctance of their GPs to refer them to a testosterone specialist. “After I scored low-normal on the blood test, I saw an endocrinologist,” one of the men told me, “and he asked me to take off my shirt. I did so, and he said, ‘You’ve got chest hair. You’ve got a goatee. Testosterone can’t be a problem.’”
I suppose there’s an infamy at play here. Testosterone supplements evoke the era of medical snake oils, of sideshow tinctures, of selling vitality tonics to withered men—the oldest swindle in the book. As well, most GPs in the Toronto area attended med school when high testosterone levels were believed to cause prostate cancer, and it’s scarcely a given that they’ve read new studies coming out of Harvard Medical School. So they’re reluctant. They need to be coaxed.
One exception is Shafiq Qaadri, a loquacious, bespectacled doctor who runs a family practice at the foot of Roncesvalles. Qaadri has written a book called The Testosterone Factor: A Practical Guide for Vitality and Virility, Naturally. He also serves as MPP for Etobicoke North; his political duties are such that he now spends just Fridays in his practice.
Qaadri’s mother was a gynecologist who treated women for symptoms related to menopause, and Qaadri grew up hearing about the importance of healthy hormone levels in the body. Fascinated, he started investigating the role hormones play in men’s health. “Fifteen years ago,” he says, “patients would come in complaining that they had no energy, that they were achy and had no interest in sex and that they were sad all the time. After testing for a number of other factors—depression, low thyroid, diabetes—I’d suggest that maybe we should test them for low testosterone, and their response would be, ‘Really?’ Today, a guy comes in, and he’s done research on the Internet, and he will tell me he’s got low testosterone and that I’ve got to give him something for it.”
There seem to be four groups of patients taking testosterone. The first are men whose ability to produce testosterone has been completely shut down by illness, testicular trauma, infection, genetic disorder or hernia surgery.
These men will score zero, or next to it, on the blood test, and there’s no controversy regarding the appropriateness of supplementation.
The second group are those men with an unseemly interest in bodybuilding, who buy testosterone supplements through online dealers. The best case scenario for them is that these products don’t work. The worst is that they do—when men with normal levels of testosterone push their T levels to stratospheric heights, the perils snowball. Synthetic testosterone is an anabolic steroid, the zealous use of which can and will cause liver damage, genital shrinkage, elevated blood pressure, rage and infertility. For this reason, doctors generally do not prescribe testosterone for purely cosmetic or athletic reasons, even though cosmetic improvements may occur as an added benefit. “You should see me with my shirt off,” one of my six low T sufferers told me. “You’d be like, ‘Holy son of a bitch!’ Believe me, I never had this kind of muscle mass before.”
The third group are men like Gary Rodger who, suffering from physical and emotional malaise, still score within the normal range for testosterone, albeit on the lower end. In his 30s, a man’s natural testosterone production begins to drop, though the rate at which it does depends on factors like genetics and lifestyle. Every man will have low T should he live long enough, and there are many doctors who believe that it is not a medical condition and therefore should not be treated. This perspective causes doctors like Larry Komer, the physician who treated Rodger, to chafe a little. “Cataracts are a natural occurrence,” he says. “Are you telling me you’re not going to treat them? Pneumonia is natural and has a 50 per cent mortality rate without treatment. Are you telling me you’re not going to take something so you don’t have a 50 per cent chance of dying? The natural argument is specious, and the people who use it always use it at certain times and not others.”
As such, there is great variance in the point at which a specialist will step in and prescribe testosterone. At the cautious end of the scale is Shafiq Qaadri, who told me, “Generally, I’ll only prescribe testosterone supplements as a last resort. Remember, no matter what people say, these are not benign substances.” Komer, meanwhile, told me the blood test used to determine testosterone levels can be vexingly unreliable and can be thrown off by a variety of factors. This was something I heard from other doctors as well: a man scoring an eight on the blood test in the morning can often go home and score a 28 the very next day. This results in frustrating delays for patients, who find themselves enduring blood test after blood test to establish a baseline. “As far as I can see, a third of all blood tests for low T in Ontario are just plain wrong,” Komer says. Faced with inconsistent scores, he often defers to what’s known as the “symptom complex” derived by the answers a patient provides on his questionnaire.
In other words, a patient can score within the normal range of a testosterone blood test and still be diagnosed with low testosterone, particularly if he has a sympathetic doctor. One of the low T sufferers I talked to—I’ll call him Dan—began suffering from irritability, mood swings and muscle weakness in his early 20s. He eventually saw Komer, who started him on an oral dose of testosterone, later switching him to injections when the pills didn’t have the desired effect. Soon, Dan began to enjoy a zesty well-being. “I started to feel so good,” Dan says, “that I talked to my friends, and four of them ended up going to get tested. Well, you wouldn’t believe it. All four of them turned out to be suffering from low testosterone.”
One way in which pharmaceutical companies market testosterone products is by providing doctors with a questionnaire for their patients. “Do you have a decrease in libido?” is the first question appearing on the checklist published by Abbott. “Do you have a lack of energy?” is the second. “Do you have a decrease in strength or endurance? Have you noticed a decrease in your enjoyment of life? Are you sad and/or grumpy? Are you falling asleep after dinner?” The list goes on, and you hardly need to be a sideshow barker to spot the bait. Everyone feels grumpy from time to time. Everyone experiences a waxing and waning of desire. Everyone enjoys life more at some junctures than others. Everyone, following a meal of turkey, mashed potatoes and gravy, will feel a little logy when sitting down to watch The National. It’s not sickness, or at least it’s not necessarily sickness, as the questionnaire clearly implies (“Please, talk to your doctor…”). Even if ill health is to blame, there are a dozen other possible culprits, chief among them thyroid malfunction, Type 2 diabetes, liver and kidney disease, and obesity.
There is yet another group of men taking testosterone supplements, using it to treat low T caused by stress. Komer sees firefighters, police officers and ex-soldiers whose low levels of testosterone are attributable, he feels, to their jobs, and he has a drawer full of police patches, given to him by grateful patients, to prove it. I also talked to one man who had previously suffered from drug-resistant depression. After years of experimentation, he finally started taking testosterone supplements in conjunction with Wellbutrin, a combination that seems to have alleviated his symptoms.
Naturally, these other applications are being regarded as yet another opportunity for the industry at large. One GP I talked to—he wished to remain anonymous—was disgruntled by a poster he saw in the office of his mother’s family doctor. The ad was topped by a headshot of a middle-aged man looking concerned, nary a bicycle nor a beaming female in sight. Beneath that was large type reading, “It has been shown that men over 45 with Type 2 diabetes are twice as likely to have low testosterone.”
Attached was a pile of tearaway “Do You Have Low T?” questionnaires patients could take home and fill out at their leisure.
There are thousands of studies, reports and articles online regarding testosterone therapy, and for every one in favour I found one that was resolutely against. I’ll say this, though: personal reports of side effects, when the products were in use, were tough to find. Some men got mild cases of acne. Some complained about a gel’s antiseptic odour. That was about it. I did find men who felt as though some magical force had returned to them an exuberance they’d once taken for granted. “I’m evangelical about this stuff,” Gary Rodger says. “That’s why I want you to use my real name. I want people to know about this. I’m a Christian and I really feel like someone reached out to help me, and now I want to do the same for others.”
I did find one widely reported drawback of testosterone therapy, a side effect that starts when the user goes off the drug. When a man takes synthetic testosterone, his natural ability to produce testosterone is greatly diminished. One 54-year-old patient whom I found on a low T chat room had his testosterone supplements discontinued when he changed family doctors. “It has been about four weeks now,” he told me, “and I feel really terrible. Depressed, kind of anxious, shaky, no energy, cannot sleep and have lost interest in sex.” Another man, who had been taking testosterone for a mood disorder, decided to lower his testosterone dose by 20 per cent once his condition had stabilized. He recounted his experience in an online video he entitled, unequivocally enough, “Testosterone Withdrawal IS HELL.”
Not that this bothered my six subjects. When talking to them, I got the distinct feeling that they all regarded their pre-supplement days as a bit of a bad dream, a groggy state they awoke from thanks to modern pharmaceuticals. While they all said their new regimen took a bit of getting used to, they also said they now barely noticed it; one described his daily application of AndroGel as just another thing he does before going to bed, a gooey mid-point between showering and brushing his teeth. All six insisted that they would never stop taking testosterone, a claim that, if nothing else, should bring joy to the hearts of anyone owning stock in Abbott or Eli Lilly. Yet hearing this always gave me pause—none of the men are over 55, and two are just into their 30s.
When I asked Gary Rodger whether he’d ever quit taking testosterone, he responded with an amused tone, as if he couldn’t believe I’d asked the question.
“I’m on it for life,” he told me. “And you know what? I’m okay with that.”