Can you turn back time?

If you’re a person with testicles you may have seen ads from online stores like UPGUYS and JACK.HEALTH promising that you can “turn back time” and “be The Guy again” by getting “your energy, muscle and love life back”

Testicles at age 60 make about half the testosterone that they produced at age 25. Testosterone levels decrease gradually over the lifespan at a rate of about 1% per year. Low T, the marketing term for low testosterone, is probably not the cause of your low energy. The more likely culprits are high stress, low exercise, social isolation, and poor sleep. All of these factors also increase your risk for cardiovascular disease, which is the leading cause of erectile dysfunction.

There is a fairly direct link between testosterone and sexual activity for men. Testosterone deficiency occurs in about 8% of men in their 50s and 40% of men in their 70s. The most common causes are obesity, COPD, diabetes, sleep apnea, alcoholism, and cannabis.

Start with a daily walk, then book a checkup with your doc to look at your 10-year cardiovascular risk score. While you’re there you could ask for a morning testosterone on your bloodwork. If it’s below the normal range for age, make sure you get a second set of bloodwork to confirm the result. 

Studies looking at the safety of testosterone therapy have conflicting results. Overall it appears to be safe for most people. There’s a Testosterone Trap though: once you start treatment it suppresses your natural testosterone production and if you decide to stop treatment you can feel pretty awful until your brain kicks back in to re-start production.

Treatment of lab-confirmed Low T with injections, gel or patches to achieve normal blood levels of testosterone improves sexual desire, erectile function, sexual frequency, mood, and bone mineral density. It  takes 3-6 months of treatment before patients achieve maximal results. Once levels are replaced to the normal range, there’s no benefit in adding more.

It is common that testosterone therapy increases your desire, but doesn’t fix erectile dysfunction. You may need to add a different pill to help with that.

Note that testosterone therapy decreases sperm production, so if you’re trying to conceive you’d better hold off on treatment. Be patient.

What if you have ovaries? Lori Brotto’s research has shown that testosterone levels are not correlated with decreased sexual interest and activity in women. That means people with low desire often don’t have low testosterone. Dr. Brotto says “It’s not your hormones.” 

The primary predictors of low desire in people with ovaries are “developmental history, psychiatric history and psychosexual history.”  Tthings like low mood, low self-image, fear of appearing sexually substandard, fear of negative outcome, or negative feelings towards the partner have the most impact on libido.

Testosterone is not approved to improve female desire, but it’s often used off-label. Over 2 million prescriptions were filled for testosterone therapy in 2006-2007. Online ads tout “bioidentical hormones” and offer unregulated and unpredictable treatment with hormone pellets. 

Supplementation does generally increase sexual activity in women, but there is often a drop-out rate of up to 50%, likely due to side effects like acne and hair growth. Only one study looked at safety at the 3 year mark, and at that time only 12% of the original 1000 women in the study were still taking their testosterone. 

If you’re a woman distressed by low sexual desire, remember that what you’re experiencing is likely absolutely normal. You’re probably one of the 85% of women who mostly have a responsive pattern of desire.  Online companies are selling their drugs as a cure for “disease”, except that responsive desire is a common and healthy state.

The treatment for low desire in most healthy people is behaviour change. Build space in your life for seeking pleasure, and prioritize and protect that space.