What you need to know about CNN’s story on young men and low testosterone

For several years now, the term “low T” has been used to market testosterone to older men who are concerned about losing their sex drive.

Critics say this marketing has convinced many men to take potentially risky drugs that they don’t need.

Now CNN has come along to alert young men that perhaps they, too, should be worried about “low T.”

In the piece Low testosterone, or ‘male menopause,’ no longer just for older men, Ian Kerner, whose web site identifies him as a licensed psychotherapist, wrote:

“In my practice, I’ve noticed that an increasing number of younger guys are complaining of sexual concerns, such as diminished libido and erectile problems, more commonly seen in older men.”

Kerner offers no evidence that libido or erectile problems are increasing in young men, or that low testosterone is to blame.

Many causes of erectile dysfunction

In fact, there’s good reason to question this premise. Justin Lehmiller, PhD, an assistant professor of social psychology at Ball State University, recently pointed out a paucity of data to back up the idea that there’s an epidemic of diminished sexual function in young men.

Even if true, Lehmiller said it would be impossible to pinpoint a cause, although he does note that “young people today are much more likely to be using antidepressants than they were in the past, which we know can cause a number of sexual side effects. There may also have been changes in condom use patterns—we know that a lot of guys have erectile difficulties when using condoms, so if guys today are using more condoms, that could translate to more difficulties.”

Of course, he’s speculating.

But in fact, sexual dysfunction in young men can result from many things, including obesity, stress, drinking, smoking, lack of exercise, depression, side effects of prescription drugs, and a host of medical conditions.

Where’s the evidence?

So if you’ve got problems in this department, low testosterone isn’t necessarily the cause. Further, studies have shown that testosterone treatment does not significantly improve erections in men with low testosterone, according to Choosing Wisely.

Nevertheless, Kerner used this opportunity to offer lifestyle advice from an $80 book edited by Andrew Weil, MD, who, Kerner writes, “recommends ‘an integrative approach to sexual health’ that assesses all the many factors that affect testosterone.”

That approach includes a wide range of interventions for which no evidence is cited — including lifting weights, eating coconut oil and grassfed beef, consuming vitamin D and zinc, and taking herbal supplements.

The column does not mention that Weil sells vitamins and herbal supplements on his web site.

One of our contributors, Richard Hoffman, MD, MPH, director of the Division of General Internal Medicine at the University of Iowa Carver College of Medicine and the Iowa City VA Medical Center, took a look at the medical literature on these suggested interventions.

His overall impression? While some research shows associations between those lifestyle interventions and higher testosterone, there’s little to suggest a meaningful benefit. “Exercising, getting enough sleep, and maintaining a healthy weight are pretty reasonable recommendations for everyone, but I won’t be recommending them to increase testosterone levels,” he said via email.

Also weighing in was another contributor, Kathleen Fairfield, MD, DrPH, a clinician-scientist based at Maine Medical Center.

“Some of the recommendations are prudent, like getting adequate sleep and avoiding a diet with excessive processed foods and simple carbs,” Fairfield said via email. “But the claims about vitamin D, zinc, and herbs for increasing testosterone are not evidence-based.”

A baseline testosterone check?

The column also suggested young men get a “baseline” check of their testosterone “so you know what’s normal for you.”

That piece of advice was also shot down by our experts. Fairfield called it “not based in science” and “not common practice.”

Another of our contributors, Alan Cassels, a pharmaceutical policy researcher at the University of Victoria, said via email, “It’s hard to see why you’d get a ‘baseline’ level other than to alter that level, with drugs.”

And again, more testosterone won’t necessarily solve your sexual performance issues.

‘Like grey hair or wrinkles’

As Hoffman put it: “Low T is a treatment in search of a disease.”

Cassels called this column a “fluff piece targeting insecure men.” He likened it to direct-to-consumer ads for testosterone drugs, which he’s criticized as inflating the market for these products, which have not shown significant benefits and have potential harms.

Cassels has also questioned terms that medicalize male aging — like “adult-onset hypogonadism” — which seem calculated to get men to worry about natural declines in testosterone.

“Let’s face it, ‘low T’ is something that is so natural most men will get it if they live long enough, kinda like grey hair or wrinkles,” he said.