February 12, 2014
By Jonathan Sackier
“T” is frequently paired with the word “level” and the phrase “should I take some?” I am talking about testosterone—man juice.
Hormones are chemical messengers driving many functions; endocrinologists are doctors focusing on this bodily system. Men and women both have circulating sex hormones; women predominantly are conditioned by estrogen and progesterone, and men by testosterone—although both have some of each. It is the balance that dictates its effects.
The Greek word orchis describes both a rare and precious flower, the orchid, and also the precious male organ, the testicles, where testosterone is manufactured. During puberty and adolescence more is produced, and it helps drive such changes as increased stature, musculature, facial hair, deeper voice, and so on.
A failure to produce testosterone may be caused by genetic or testicular developmental problems, trauma, or more complex issues; this usually is recognized by parents or pediatricians and replacement therapy is initiated. For adults the story is more subtle.
T naturally decreases with age, about 1 percent per year after 30 years. Testosterone levels are measured with a simple blood test and, when low, result in body hair loss, fragile bones, anemia, diminished libido, erectile dysfunction, increased body fat, lethargy, depression, decreased memory and concentration, and disturbed sleep. Because these changes occur over time, men—or their partners—may not register the metamorphosis. And then along comes the Internet and TV advertising, and everyone and their uncle is talking about T.
Excessive alcohol consumption can lower T levels, but abstinence may provoke a turnaround. Loss of one or both testicles can lower testosterone levels. Obesity, various chronic illnesses such as kidney disease, corticosteroid drugs, and those used to treat prostate cancer also can be culprits.
If symptomatic, see your doctor; request a blood test; and, if levels are low, consider seeing an endocrinologist to obtain therapeutic advice. Self-medication by purchasing online is not ideal as all benefits and risks cannot be covered, and the sale of counterfeit drugs from overseas vendors is a concern.
In the absence of heart, liver, or kidney disease, which may be worsened by fluid retention; prostate or breast cancer, which are contraindications to treatment; or sleep apnea, which can be exacerbated, replacement therapy can be delivered as an injection every one to three weeks, a small sustained-release pellet implant under the skin, a patch, tablets, or gels. The latter are popular and applied daily to stomach or shoulders, rubbing in thoroughly, and then washing the hands carefully to ensure family members or pets do not get an unwanted hormone boost. Improvements will declare themselves rapidly but side effects include local irritation from alcoholic gels, breast enlargement, aggressive mood changes, acne, testicular shrinking, blood pressure changes, impaired urine stream, or waking to use the toilet. Additionally, bone marrow may manufacture too many red blood cells, and for these reasons, medical supervision is sensible.
Hypogonadism might require special issuance, otherwise report testosterone treatment, which is acceptable to FAA, to your AME, entering status and drug in section 17 noting any side effects. If you have any doubts or concerns, join AOPA Pilot Protection Services to help you avoid another kind of T—Oklahoma City-induced terror!
Although rare—accounting for around 1 percent of male malignancies—cancer of one or both testicles is quite nasty and most common in young men. However, early detection allows successful treatment to achieve a cure. No known activities or lifestyles, such as bike riding, have been implicated, although family history, a previously undescended testicle, or impaired development might play a role.
The most potent way to tackle this problem is learn how to self-examine once a month. After a warm bath or shower, stand in front of a mirror and ascertain if the skin looks different while looking for any change in size, a lump, fluid in the scrotum, or a dull ache in the area or lower abdomen. It is normal for one side to be larger and lower than the other; get used to what “your normal” feels like. Pain is rarely an issue and most cancers are found by the patient. Once dealt with, a special issuance is required.
If you see folks wearing a royal blue ribbon next month, this is for April’s testicular cancer awareness month. Self-exam, and know yourself to a T! Don’t be an April fool and check your undercarriage.
Dr. Jonathan sackier is an active general aviation pilot and British-trained surgeon living in Virginia.
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