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Monday, February 29, 2016

Testosterone: Does Ryan Hall have too little or does America have too much?

FILE - In this April 18, 2011 file photo, America's top marathon runner Ryan Hall runs ahead of a group of elite runners during the Boston Marathon in Wellesley, Mass. Hall finished fourth in the event. Hall confirmed Thursday, July 28, 2011, that he plans to run  in his first Chicago Marathon on Oct. 9 and hopes to set a U.S. record doing it. (AP Photo/Steven Senne, File) (Steven Senne, ASSOCIATED PRESS)
Ryan Hall competing.

Very interesting article. As we have always said, testosterone levels, like many other things, have been politicized by ignorant people who have no clue what the real issues are. This is a great story about a real individual who struggles with real issues.

In January, Ryan Hall, the fastest American-born marathoner, abruptly announced that he was retiring, in part because of chronically low testosterone that contributed to extreme fatigue and interfered with his training.

Hall’s announcement shocked fans of long-distance running, and perplexed people who've seen ads for testosterone clinics that promise to restore flagging vitality with a cream or shot. Why couldn't the 33-year-old Hall, like millions of other American men, just get a prescription for testosterone and keep running?

The answer isn’t as simple as the multi-billion-dollar industry makes it seem.

Low testosterone, or hypogonadism, can cause a range of health issues including infertility, decreased muscle mass, fatigue, weight gain, fuzzy thinking and low sex drive. But its treatment carries risks, including the potential for blood clots, prostate cancer and heart disease, according to the Mayo Clinic.

Nonetheless, the number of prescriptions nearly doubled between 2009 and 2013, from 1.3 million to 2.3 million. This prompted the Food and Drug Administration to warn that men should take testosterone only for diagnosed medical conditions, not to feel more energetic or try to thwart the natural consequences of aging.

One quarter of those receiving prescriptions never even had their testosterone levels checked, the FDA said.

That hasn’t stopped men — and some women — from using gels, creams and shots to increase their "T-levels," hoping for increased energy and strength, weight loss and improved mental focus.

“A lack of testosterone doesn’t kill you, but it’s like oil for the engine. Everything runs better when it’s normal,” said Dr. Paul Turek, a men's fertility specialist and director of the Turek Clinic in Los Angeles and San Francisco.

A study published last week in the New England Journal of Medicine said men who used a testosterone gel reported better sex, and modest improvements in mood and energy. More studies are needed, however, to evaluate long-term risks, the authors said.

'A hot-button banned substance'

Testosterone is a hormone that, in men, is produced largely in the testes. It's responsible for sexual development and desire, muscle strength and size, and the production of sperm and red blood cells. While popularly known as the male sex hormone, that's an "indefensible" label, according to University of Cambridge emeritus professor of neuroscience Joe Herbert, who notes that women have testosterone, too (though 1/10th the levels of men), as well as birds, fish, reptiles and other mammals.

Hall, a devout Christian who owns the fastest American time in the half-marathon, was a superstar runner at Stanford University and reportedly learned of his low testosterone levels after graduating in 2006 and turning professional.

Hall has said he tried to elevate his levels by eating more fat and lifting weights, with no success. He refuses to take a synthetic androgen because it causes the body to stop producing testosterone naturally.

There’s also the matter that synthetic testosterone is considered a performance enhancing drug and is prohibited for athletes.

Hall could have applied for special permission (called a therapeutic-use exemption), but he has said that “crosses a moral line that I am not willing to cross.”

"Also it’s such a hot-button banned substance, it didn’t feel fair to me that I could be taking testosterone while it seems to be so clearly a performance-enhancing drug," he told Erin Strout of Runner's World.

As a professional athlete who regularly logged more than 100 miles a week, on punishing inclines and at speeds most people can’t achieve, Hall’s training may have contributed to the condition, some observers say.

“Researchers have known since the late 1980s that chronic and extreme endurance training has a tendency to lower testosterone levels, causing depression, fatigue, and lack of motivation. More recently, however, exercise-induced low testosterone has been recognized as one of many common biomarkers for a more systemic breakdown: training that is so hard, frequent, and long, and with such inadequate rest along the way, that fitness, performance, energy levels, and mood all fall off a cliff,” Daniel Duane wrote earlier this year in Men’s Journal, calling Hall’s saga “a cautionary tale.”

Ironically, however, when testosterone makes the news in connection with athletes, it's usually because a blood test found they have too much. In 2014, a female sprinter from India was initially barred from competing against women because of naturally high testosterone levels; the ruling was later overturned. And testosterone was among the performance enhancers that superstar cyclist Lance Armstrong confessed to using.

From monochrome to color

But then there's the experience of Rebecca Watson, a mother of five in Atlanta, who was determined to find out why her husband was lethargic, gaining weight and uninterested in sex a decade ago. When she first proposed to him that low testosterone might be the problem, like many men, he didn't want to accept it, since the hormone is popularly considered a barometer of masculinity.

But just weeks after beginning therapy, Watson said, her husband felt markedly better, like going from seeing black-and-white to color. The therapy may have saved the couple's marriage, she said. A health-and-wellness coach, Watson shared their experience on her blog (called High T Marriage) and in a book, called "I Want Sex, He Wants Fries," hoping to help others in similar situations.

"I can’t tell you how many times my husband has thanked me," Watson said. "He’s a better dad, he’s a better husband, he’s happy again. He’s thanked me over and over for being willing to push that issue when he didn't want to."

That said, she recommends that men first try natural ways to increase testosterone before resorting to prescriptions. There are many reasons testosterone declines other than the predictable dips that accompany aging. Watson believes chronic exposure to plastics and pesticides is one reason. Stress is thought to be another.

How many men have low testosterone remains in dispute. One Massachusetts study said 1 in 4 men over the age of 30 have low levels, but only 1 in 20 exhibit symptoms. An editorial published last year in the Journal of the American Geriatrics Society said the incidence that justifies treatment is 0.5 percent.

Researchers don't agree on why, but there is evidence of a generational decline in testosterone levels.

In 1988, 50-year-old men in one Massachusetts study had higher concentrations than 50-year-olds tested in 1996. "This suggests that some factor other than age may be contributing to observed declines in testosterone over time," lead author Thomas G. Travison said in a news release.

There have been similar reports worldwide, but Herbert, the author of "Testosterone: Sex, Power, and The Will To Win," said it's possible that more men are being tested, and the tests are more accurate than they have previously been.

"I think we need to treat this data cautiously," he said in an email. "Of course, it could be that the lower T levels are correct, and men are just more stressed."

Turek, whose clinics treat a range of men's health issues, agreed that stress is a major cause of low T in America. (He also notes that Hall's struggles with testosterone may be a result of his training: "Long-distance running is constant stress," he said.)

Turek cites a study of soldiers whose average testosterone levels fell by 30 percent after 84 hours of exertion with little food and sleep. Most men won't be exposed to that level of stress, or Hall's, but the stress from everyday life, whether it be finances, work or a constantly pinging smartphone, has the same effect on testosterone as physical stress, he said.

There are other factors at play, as well. Obesity lowers testosterone, as does marijuana and opiate use, and any kind of pain medication.

And Herbert notes that winning a sports match — or even a computer game — can increase testosterone, but losing at anything decreases it. (He quips that to raise testosterone levels naturally, men should "win something" or get a promotion.)

What's normal

Because testosterone levels vary with age, there is no one standard for what's normal. But generally, men's levels should be between 300 and 1,000 ng/dL (nanograms per deciliter) and women's, between 15 and 70.

Levels are always in flux, which is why people should have their blood tested in the morning, when testosterone usually peaks. (Watson recommends that her clients get a baseline test in their late teens or early 20s, so they will have a comparison point when levels start to decline in their 30s.)

Like Watson, Turek said men should try to raise their levels naturally before turning to prescription gels, shots, creams or even pellets implanted in the hip. “Treat your body like a temple, eat well, sleep well, understand your stressors. Men need to get physically tired to reduce stress," he said.

While they may yet need testosterone therapy, all this might help, and Turek, who treats professional athletes in his practice, said Ryan Hall might find his low-T issues subside after taking a sabbatical from running.

"One of the healthiest things Ryan could have done is stop running," Turek said. "He'll be back."



EMAIL: Jgraham@deseretnews.com
Testosterone is not limited to males, although as the article makes clear, they have much more of it.

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