Male hormone health risk warning analysis report

The detection rate of late-onset hypogonadism (LOH, or insufficient secretion of male hormones) in men aged 30-50 in my country has reached 37.2%. Among them, 41% of patients mistakenly attribute signs of fatigue, abdominal obesity, and irritability to "being tired" or "older," and are completely unaware of the correlation with hormonal disorders.； Currently, clinical intervention is divided into two schools: "exogenous supplementation first" and "lifestyle adjustment first". The applicable scenarios of the two are very different, and there is no universal optimal solution. Misjudgment will increase the risk of autologous secretion suppression.

Last month, I met a 38-year-old backend of a gaming company at the outpatient clinic. He had a belly circumference of 92cm. He had only slept 4 hours a day for 3 months working on projects. When he came in, he had a slumped face and said that he had been feeling tired for the past six months. He couldn't even climb the second floor without gasping for breath, and his married life was not exciting. He secretly bought thousands of yuan of kidney health supplements, but it was useless. The total testosterone was only 289ng/dl, which is a bit lower than the minimum reference line for adult men of 300ng/dl. This is not an isolated case. I have received similar patients in the past six months, which is almost twice as many as in 2019.

Many people's understanding of androgen is still at the level of "relating to sexual function". In fact, it is one of the core regulators of male body metabolism. Many of what you think of as "minor problems" are actually the red light of it. For example, you may not eat much, your belly will be bloated in circles, your muscles will not grow even after practicing for a long time, you will still feel groggy even after sleeping for 8 hours, and you may even want to lose your temper for no reason. These are easily ignored signs that actually point to a decline in testosterone levels.

Abdominal obesity is the number one cause of obesity that has been fully confirmed by academic circles. To put it bluntly, for men with a waist circumference of more than 85cm, the aromatase in the visceral fat will continuously convert testosterone into estrogen, which is equivalent to "cutting off" the male hormones in the body and transforming them into opposite-sex hormones. This is why many obese men will have breast development and less body hair. It is not surprising at all. As for the impact of staying up late that everyone often talks about, there is still some disagreement in the academic community: The clinical data produced by one group is that healthy men who slept less than 5 hours a day for 7 consecutive days had an average decrease in total testosterone levels of 15%, which is equivalent to the decrease in natural aging of 10-15 years old. ； The other group believes that as long as there is a fixed circadian rhythm, even if you stay up until 3 o'clock and go to bed at 12 noon all year round, the impact on testosterone is much less than irregular fragmented sleep. The cases I encountered in the clinic are also consistent with this statement. Most of the testosterone levels of game anchors who stay up late all year round are normal. On the contrary, the abnormality rate of operation employees who often go to bed early one day and stay up late the next day is ridiculously high.

Currently, there has been a clinical debate in two directions regarding the intervention of low testosterone. No one is right or wrong, but the applicable groups are different. One group is the "supplement group" that advocates direct exogenous supplementation. It is suitable for patients whose total testosterone has been lower than 230ng/dl, has experienced decreased bone density, severe decline in sexual desire, or even erectile dysfunction. Exogenous testosterone ester injections or patches have a very fast onset of action, and most of them can see obvious results in 1-2 months. There is a significant improvement, but it should be noted that there is currently no clear cause-and-effect conclusion in the academic community as to whether exogenous supplementation will increase the risk of prostate cancer. Therefore, the prostate-specific antigen (PSA) must be checked every 3 months during the medication, and you must not buy testosterone injections from the black market privately. The other school is the "conditioning school" that advocates adjusting lifestyle first. It is also the plan that I personally recommend for patients with mild symptoms. It is suitable for people whose total testosterone is in the critical range of 230-300ng/dl and who have not yet developed severe organic symptoms. Last year, I treated a 34-year-old Internet operator with a waist circumference of 91cm and a total testosterone of 287ng/dl. I did not give him a prescription. He Yao asked him to do strength training for more than 40 minutes three times a week, replace the three cups of milk tea he drank every day with sugar-free drinks, and avoid refined carbohydrates. After three months, his waist circumference dropped to 82cm, and his total testosterone reached 458ng/dl in a follow-up test. His mental state was completely different. He said that he used to drink coffee when he was sleepy in the afternoon, but now he can play ball for an hour after get off work.

In fact, you don’t have to wait until you feel unbearable before going to the hospital. You can do a preliminary screening at home: If your waist circumference has increased by more than 5cm inexplicably in the past six months, if you can now do 5 of the 10 push-ups that you could easily do before, if you still feel tired all day long after sleeping for 8 hours, if your mood is always emo or explosive, or if your interest in sex life has dropped significantly, then take the time to go to the doctor. Go to the men's department or endocrinology department in the hospital and check six items of sex hormones, which only cost more than 100 yuan. Don't blindly buy the "testosterone supplements" and "impotence pills" that are hyped online. Many illegal products are added with sildenafil or exogenous testosterone analogues. They may seem useful at the moment, but over time, they will suppress your own testosterone secretion, turning what was originally a critical problem into a permanent one. The gain outweighs the gain.

To be honest, I have been doing endocrinology for almost 10 years, and I feel that men pay too little attention to their hormonal health. They either feel that it is too private to ask, or they feel that it is a normal phenomenon of old age and should not be ignored. In fact, whether the testosterone level is sufficient is not only related to that matter, but also a weathervane of the metabolic status of your entire body. It is better to pay attention and adjust early than to worry when you have to take medicine and injections, right?