The sex hormone testosterone gives a man his beard, deep voice and sex drive. It also may give all of us–men and women–better health and a longer life.

Research shows that low levels of testosterone may increase the risk for heart disease, stroke, type 2 diabetes, osteoporosis, depression and Alzheimer's disease. Low testosterone also can trigger fatigue, low libido, erectile dysfunction, enlarged prostate (benign prostatic hyperplasia), muscular weakness, poor endurance, irritability, poor concentration and poor memory. What you need to know now…

Live Longer

An estimated 40% of men age 45 and older have testosterone deficiency-total testosterone below 300 ng/dL. (This phenomenon is called by various names, including andropause, male menopause and hypogonadism.) This deficiency is linked to…

  • Cardiovascular disease (CVD). In a four-year study, men with one risk factor for heart disease (such as high blood pressure) were four times more likely to develop CVD if they had low testosterone. Other studies link low testosterone to an increased risk for stroke, blood clots, high total cholesterol, high LDL "bad" cholesterol and arrhythmias (irregular heartbeats that can trigger a heart attack or stroke). One such study concluded that "testosterone levels may be a stronger predictor of coronary artery disease than high cholesterol, blood pressure, diabetes, smoking and body mass index."
  • Metabolic syndrome and type 2 diabetes. Metabolic syndrome—a risk factor for type 2 diabetes-isa constellation of health problems that can include insulin resistance, abdominal obesity, high blood pressure, high triglycerides and low HDL "good" cholesterol. In a recent two-year study, metabolic syndrome was completely reversed in 65% of men on testosterone replacement therapy (TRT).
  • Osteoporosis. A study found that men with low testosterone had an 88% higher risk for hip fracture.
  • Midlife male depression. A study from Columbia University showed that TRT completely reversed depression in more than 50% of depressed men.
  • Alzheimer's disease. Research links higher levels of testosterone with better blood flow to the brain, better memory and less risk for Alzheimer's disease.
  • Death from any cause. In a study of 900 men, those with low testosterone had a 43% higher risk for all-cause mortality (dying from any cause). In another, seven-year study, every 173 ng dL increase in total testosterone levels was linked to a 21% lower risk for all-cause mortality.

Testosterone Testing

The Androgen Deficiency in the Aging Male (ADAM) Questionnaire (see page 320 in the Men's Health chapter) can determine if you have symptoms of low testosterone. If you do, you should be tested for a low blood level. However, you can have so-called "normal" test results for total testosterone and still have a deficiency. That's because testosterone may be bound to a compound called sex hormone binding globulin, so only a small percentage reaches your cells.

Best: Ask your doctor to test you for total testosterone and free (unbound) testosterone. You may need a doctor trained in the use of bioidentical hormones or a naturopathic physician.

Another problem with testosterone tests is that "normal" values vary widely from laboratory to laboratory. One study from Harvard Medical School found 17 different sets of "normal" values for total testosterone among 25 labs.

What to do: If you have the symptoms of low testosterone...and your level of either total or free testosterone is below normal or borderline normal at whatever lab your doctor chooses... you should consider TRT.

Standing Could Save Your Life

Among more than 200,000 adults age 45 and older, those who sat for 11 or more hours a day-at home, at work or in their cars-were 40% more likely to die of any cause over the next three years than those who sat for fewer than four hours daily.

Explanation: Physical activity of any kind–even standing–is crucial for longevity.

Make Lifestyle Changes

If you have low testosterone, you can first try to boost it by…

  • Losing weight
  • Managing stress
  • Weight-training
  • Getting eight hours of sleep
  • Eating healthy, monounsaturated fats and limiting processed carbohydrates, such as sugar and white flour
  • Eating organic food (estrogen-like pesticides can stymie testosterone).


If you still have low testosterone after making lifestyle changes, you may need TRT. There are four forms of TRT for men. All are effective and safe. You and your doctor can determine the best treatment for you…

  • Prescription 1% or 1.62% testosterone gel, such as Testim and AndroGel, which is applied once a day.
  • Testosterone injections, which typically are given once every two weeks, though some doctors prefer to give them once a week.
  • Testosterone pellets, which are surgically inserted.
  • Compounded 1% to 10% testosterone cream is custom-formulated by a compounding pharmacy and applied once a day.

Whatever the form of testosterone, the following is advisable…

  • Aim for a total testosterone blood level of 600 ng/dL or just a little higher (up to 900 ng/dL).
  • Recheck blood levels. Many primary care doctors prescribe testosterone gel-and never recheck their patients. Your doctor should check your levels after one month...then every three months for one year...every four months for the second year.. and every six months for the third year and thereafter.

Women And TRT

A deficiency of testosterone in perimenopausal or menopausal women can cause symptoms similar to testosterone deficiency in middle-aged and older men, such as fatigue, depression, weight gain, low libido and osteoporosis.

What to do: Ask your doctor to test your free testosterone. If your level is low, consider treatment with testosterone cream from a compounding pharmacy at a dose of 0.5 milligrams (mg) to 2 mg daily. (This is an off-label use of testosterone, not approved by the FDA) Most women notice more energy, younger looking skin, thicker hair and increased libido.

Some women worry that testosterone will give them "manly characteristics, but this does not happen with female-appropriate doses.

Simple Test May Reveal Longevity

According to a recent study, more than 2,000 healthy adults (average age 62) were scored on the number of hand, knee or other supports required to sit on the floor and then stand unaided.

Result: Those who needed the most support had up to six times greater risk for death than those who needed the least support.

Theory: These movements indicate musculoskeletal fitness, a key component of longevity.

Self-defense: If you require more than one support to sit on or rise from the floor, talk to your doctor about ways to improve your muscle strength and flexibility.

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