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