“It’s a big fat ‘Oh no,'” Anawalt said in reaction to Hegseth’s announcement. “We’re turning back the clock on rational health care. … I worry about ethics. I am worried about the health consequences. I am concerned about the unnecessary assessments, misdiagnoses and misdiagnoses that lead to inappropriate testosterone prescriptions.”
To understand why, let’s start with a basic question: Why might someone have low testosterone?
“Low T” causes
Diseases that can cause low testosterone include genetic conditions, for example Klinefelter’s syndrome (when a man has an extra X chromosome) or a problem with the pituitary gland in the brain, which controls hormone levels in the body. Pituitary problems can result from damage, dysfunction, or tumors (often non-cancerous).
For these patients, “It’s not difficult to make a diagnosis,” Anawalt said. Genetic testing can detect Klinefelter’s disease, for example, confirming the explanation for low testosterone levels. Similarly, in patients with pituitary problems, tests for other blood hormones (such as luteinizing hormone and follicle-stimulating hormone) can confirm the source of the problem.
But these conditions are rare, affecting at most 1 percent of men, Anawalt said.
At the same time, many other things can lower testosterone levels, such as: cancer treatment, drugs (such as corticosteroids or opioids), anabolic steroids, obesity, HIV, surgery, trauma, stress, lack of sleep, and the natural aging process. Many of these causes do not require testosterone replacement therapy. The best treatment for someone with insomnia, for example, is rest.
Symptoms
Early symptoms in patients with true hypogonadism include low libido, erectile dysfunction, decreased sperm count, breast enlargement or tenderness, decreased energy, decreased muscle mass, shrinking testicles, mood changes (such as irritability or depressed mood), and hot flashes. Over time, low testosterone can lead to a loss of body hair, muscle mass, and bone density, and can reduce the number of red blood cells.
