HCG is used as a fertility treatment, but since I’m blessed with three beautiful children already, I’m in no need of a sperm booster. Rather, this shot is meant to jump-start my testes to produce more testosterone, because as it turns out, my T tank is nearing E. See, about a month ago, I decided to get my T levels checked. This isn’t a routine screening for men my age—I’m 52—but a growing chorus of doctors thinks it should be. I’m one of an estimated 5 million men in the United States who have been diagnosed with low testosterone, and according to some estimates, another 12.5 million American men may have the deficiency. As testing becomes more commonplace, the diagnoses may be rising. From 2001 to 2011, the testosterone prescriptions written for men age 40 and up increased more than threefold. Experts are divided on whether that’s a good thing, with skeptics citing a lack of long-term evidence that T therapy is safe or effective. But my doctor, Florence Comite, MD, an endocrinologist in New York City, is all for it. I submitted to Dr. Comite’s extensive medical evaluation for journalistic reasons—to edit the book she wrote for Rodale (publisher of Prevention) called Keep It Up: The Power of Precision Medicine to Conquer Low T and Revitalize Your Life. Dr. Comite found that my total testosterone was low, at 244 nanograms per deciliter (ng/dl); normal is 300 to 1,000. A second test, considered more telling because it measures “free” testosterone—the type that binds with receptors all over the body—was very low, at 45 picograms per milliliter. “Forty-five is about the level of a boy just starting puberty,” Dr. Comite says, adding that free testosterone should be between 150 and 250 pg/ml. Her statement hit me like a kick in the groin. Testosterone is what makes men men. It’s vital sustenance for muscle mass, bone density, and body hair. T drives the development of male reproductive tissue, such as the testes and prostate. It plays a role in every major organ system, from the arteries to the brain. “Testosterone is the rocket fuel that has powered your health, energy, sexuality, and state of mind for most of your life,” Dr. Comite says. Needless to say, it’s not something I want to live without. MORE: 8 Surprising Marriage Insights From Divorce Lawyers But me, really? Low T? Emasculated at 52? At first I deny it. While my libido may have dipped since my randier 20s, it’s still strong. I’m in good shape. But I am a little doughier all around. I can’t bench-press 280 anymore, and long runs have become jog-walks. And then I learn something more from my blood work, equally as surprising as the low-T diagnosis: I have prediabetes, as determined by a high hemoglobin A1C, or HbA1c, score. And diabetes, it turns out, is common among men with low T. “HbA1c is a very good indicator of longevity,” Dr. Comite tells me. Great; I just failed the longevity test, too. Starting in his late 30s or early 40s, a man’s testosterone level begins to wane; it drops by 1 to 2% per year after age 40. At that gradual rate, most men don’t notice the decline until they hit their 50s, when symptoms such as reduced energy, loss of libido, and weaker erections can start to appear. The medical term for low T is hypogonadism, but it has also been described as “andropause” and “male menopause,” because these changes are similar to the hormone plunge that occurs in women when ovulation ends. I learn that my pharmaceutical T-raising options are many: rub-on gels, testosterone injections, under-the-skin implants, hCG. Dr. Comite recommends hCG for guys like me whose bodies haven’t completely stopped making T, because hCG mimics luteinizing hormone, the natural “start” button for T production. She says that it helps the body help itself by producing its own testosterone. There are likely additional benefits, too. Reduced belly fat, higher bone-mineral density, more muscle, and improved sexual function are common outcomes of higher testosterone levels. Sounds like all good news, but there’s another side to T therapy. Pharmaceutical companies spent more than $100 million to promote treatments for low T in 2012 alone; this has some experts on alert. Last year, Lisa Schwartz, MD, and Steven Woloshin, MD, co-directors of the Dartmouth College Center for Medicine and the Media, wrote in JAMA Internal Medicine: “Whether the campaign is motivated by a sincere desire to help men or simply by greed, we should recognize it for what it is: a mass, uncontrolled experiment that invites men to expose themselves to the harms of a treatment unlikely to fix problems that may be wholly unrelated to testosterone levels.” T therapy is also controversial because of the lack of any large, extended studies that convincingly establish its safety and efficacy. Wary doctors cite what they view as overblown claims of uncertain benefits, and they warn of underappreciated risks like breast enlargement, testicle shrinkage, infertility, enlarged prostate, prostate cancer, and heart attack. One 2010 study of men using gel, reported in the New England Journal of Medicine, renewed the debate. It was halted for safety reasons when some participants experienced cardiovascular problems, including heart attacks. (Advocates of T therapy point to studies that found no connection to heart attack risk and that even suggested it could promote heart health.) “Men treated with testosterone must be monitored to reap the benefits and minimize side effects or risks,” Dr. Comite says. For the above reasons, I struggled with the choice to try hCG. I don’t like to mess with nature. Plus, insurance doesn’t cover hCG for this use. It costs about $100 a week. That’s a high price for vague notions of libido, energy, and mood. But I decided to go ahead with it. If a needle prick twice a week can help me battle the diseases of aging, I’ll try it. And if I can feel stronger, sharper, and more energetic and keep my sex drive humming into my 80s, that’s a plus. I wipe my skin with an alcohol swab, pinch my belly flab, and plunge the needle. MORE: How To Want Sex Again It has now been a year since I started hCG. I am not as tired after a workout and seem to recover quickly. I have gained an inch on my arms and notice veins popping through tighter skin. I had to buy new jeans; the old ones were falling off me. People ask me if I’ve lost weight. Actually, I’ve gained 4.5 pounds. A full-body composition scan taken at the 6-month mark showed why: I added 10.3 pounds of muscle while losing 6 pounds of body fat, primarily in my belly. My libido is about the same—“healthy,” Kathy reports, God bless her. And I’ve welcomed back morning erections. (Diana Kirschner, PhD, a psychologist whose husband, Sam, is on T therapy, says, “After decades of marriage, we’re having sex twice a day, like 20-year-olds!” Other wives of Dr. Comite’s patients have requested she dial T levels down because they’re exhausted.) My total testosterone has risen to nearly 700, and my free T has tripled. Best of all, my HbA1c has dropped to 5.7—not ideal, but it’s on the line between normal and prediabetic. (While the hCG played a role here, the blood-sugar-regulating metformin pills Dr. Comite prescribed likely did, too.) Can I maintain those gains without a biweekly booster shot of hCG—and the $400-plus monthly bill? For now, I’ll attempt to keep my T levels high using natural methods, and there are several that hold some promise, including one that I’ve already accomplished: losing fat. “That’s the best natural testosterone booster,” says Scott Isaacs, MD, medical director of Atlanta Endocrine Associates. “For more than 50% of people who have low testosterone, weight is a critical factor. My patients very often get their testosterone to normal through diet and exercise.” Being more diligent about the gym may help, too. Heavier weights, more volume (2 to 4 sets of 8 to 15 reps), and resting for less than 2 minutes between sets will kick T levels up a notch, according to a 2012 study. And all that exercise should help me sleep deeply, another natural T booster. Someday my testes will stop producing testosterone, and I may consider synthetic T therapy. Until then, I’m proud that I’ve already taken an unusually proactive approach to my health. I think of my grandfather Janos, who couldn’t benefit from the new efforts against the debilitating diseases of aging. His final years were spent sitting in pain in a stiff chair, looking forward only to his Yankees games and a weekly shot of Wild Turkey. “Same as dead,” he’d say to me, resting his chin on his cane. It’s a fate I’m unwilling to accept. I want to be alive and active for another 40 years. If that means T for me, hand over the syringe. In this case, Neil Young was wrong: The damage may be done if I don’t shoot up. Drug-Free T Enhancers—And Detractors The natural solutions to try before the syringe:Drinking pure pomegranate juice increased salivary testosterone levels by an average of 24%, found a study from the Society for Endocrinology in the United Kingdom.Avoiding cans and plastic food and drink containers made with bisphenol A (BPA), a known endocrine disruptor, may help protect testosterone levels.Studies show that men who eat plenty of monounsaturated fats—found in avocados, olive oil, and nuts—tend to have higher T levels.Some soaps, shampoos, and other products contain triclosan, which animal studies suggest can lower testosterone.The plant extract fenugreek can help raise free testosterone levels, says Florence Comite, MD. Supplements that contain it include Testofen. MORE: How Viagra Is Changing Marriages—And Not Necessarily For The Better
