A Better Understanding of Sex Hormones in Men


Testosterone is one of the most over-prescribed and poorly understood medications. It is prescribed to millions of men for myriad indications, many of them unproven. Athletes believe it will improve their muscle mass and strength. Older men look to it as an anti-aging remedy. Men with flagging libido hope it will restore their sex drive. Testosterone has developed a mythology of masculinity. This is very similar to the notions we had a generation ago about estrogen being a fountain of femininity before anyone actually studied it.

Part of the difficulty in deciphering the actions of testosterone has been that testosterone is naturally metabolized in men’s bodies to estrogen. The concentration of testosterone in our blood is ten thousand times greater than that of estrogen, but estrogen clearly has important effects in men which are independent of the effects of testosterone. Sorting out which hormone does what has been challenging.

This week the New England Journal of Medicine (NEJM) published ” target=”_blank”>Middle-Aged Men, Too, Can Blame Estrogen for That Waistline (NY Times)
” target=”_blank”>Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men (NEJM article)
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