Low T myths and misconceptions, with James Hotaling, MD

Approximately 40% of men age 45+ experience low testosterone (low T), but myths and misconceptions about the condition are common — and open conversations about it are rare. We talked with James Hotaling, MD, MS, FECSM, a member of Carrot’s medical advisory board, about what he wants more people to understand about low T and why personalized care is crucial for those experiencing symptoms.

What would you say are the biggest misconceptions you hear from patients about low T?

The most common misconception I hear is that everyone should be on testosterone and that it is a panacea for any type of psychological issue, such as depression or low energy. While testosterone replacement therapy may be an option for some patients, we also typically consider lifestyle changes like increasing exercise, maintaining a balanced diet, and avoiding excessive alcohol consumption.

Another big misconception is that taking testosterone does not impact fertility. This is completely untrue. Taking testosterone lowers levels of other hormones needed for sperm production. This can lead to someone producing no sperm or significantly decreased sperm levels.

I’ve also heard from more patients in recent years who purchased testosterone online without a prescription. This is not advisable because again, taking testosterone can have significant side effects, including decreasing sperm production and testicular atrophy (shriveled testicles). In general, individuals should avoid starting any supplements without talking to a doctor first, but taking testosterone without a doctor’s supervision can be particularly harmful.

What are the most impactful or disruptive symptoms of low T, in your view?

Low T can affect many different aspects of a person’s life. Many patients come in with concerns related to energy levels, loss of muscle mass, and low libido. In terms of symptoms that can impact someone at work, low energy and poor concentration can be particularly disruptive. Low T is more common in males over 40, so you could start experiencing these difficult symptoms when you’re at the peak of your career, which can be difficult to manage emotionally.

If someone is looking to grow their family, low libido can impact those goals, and as I mentioned, taking supplemental testosterone hurts rather than helps fertility. That’s why receiving a personalized care plan that takes all of a patient’s goals into account is so important.

There isn’t a lot of awareness around low T. Why is it important that more doctors talk about it?

A slow decrease in testosterone levels is a normal part of aging, and the average person doesn’t require treatment for these age-related decreases. But for a portion of the population, testosterone levels become low enough that symptoms start impacting daily life. When people start experiencing low T symptoms, many think it must be part of aging, and there isn’t anything they can do about it. It’s important that doctors raise awareness about this lesser-known condition and educate patients about it, so they’re informed and engaged in their health and can access the right treatment options for them. For patients who are experiencing these symptoms and have documented low T, it’s important to partner with a doctor to come up with a treatment plan which can significantly improve symptoms and overall quality of life.

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