Is testosterone the new performance hack for executives?

Globally, testosterone replacement therapy is booming as more male professionals question whether declining hormone levels may be affecting their energy, mood and performance at work. But the answer lies in careful medical assessment rather than assumption, writes The European’s Strategy & Creative Intelligence correspondent, Steve McCauley

You know that something is going mainstream when posters appear for it on the London Underground. Cue testosterone therapy and advertising straplines such as “Men get hormonal too”.

American health podcasts hosted by experts such as Professor Andrew Huberman and Dr Gabrielle Lyon are helping drive interest, as is social media discussion. The claimed promise of testosterone therapy is that it can be transformative for a man who is deficient in the hormone. 

And men seem to be listening. Industry analysts project a steady growth in the global testosterone therapy sector, already worth some $2billion USD, over the next seven years, reflecting increased prescription rates, private clinic activity and broader consumer awareness.

But is this just the latest wellness industry trend or might it dramatically improve your life and your professional career? 

After all, testosterone is vitally important for men. It is the primary sex hormone involved in producing male characteristics. It is associated with ‘masculine’ behaviour in mating, aggression and dominance, as well as a deep voice and facial hair. It is involved with many functions, including the regulation of mood and cognition, as well as metabolic, cardiovascular and bone health. Low levels of testosterone in men may lead to problems with libido and erectile function, as well as lower mood, energy and physical endurance, weight gain and even osteoporosis. 

For executives and leaders, those effects are not trivial. Sustained fatigue, reduced concentration and low mood can erode decision-making, resilience and day-to-day performance long before they are recognised as medical issues.

In order to separate signal from noise, I spoke to Dr Reamika West, who specialises in hormone medicine at London Bioidentical Hormones, a clinic which treats both women and men in the UK. 

Testosterone replacement therapy (TRT) in men does what the name suggests: it supplements testosterone when a doctor has determined that there is hypogonadism — a failure to produce sufficient testosterone naturally. 

Dr West explained: “Typical symptoms of testosterone deficiency in men that most people might intuitively think of would be a low sex drive, or erection difficulty. In addition to that, low mood can be a symptom; brain fog, fatigue, a loss of enthusiasm for life. Or a change in body composition, of losing muscle and gaining fat, particularly around the belly. 

“Some men experience reduced exercise recovery, diminished strength and reduced motivation. Some experience thinning of their hair and a loss of body and facial hair. Some may even get hot flushes, just like women during menopause. It points to just how many functions of the male body in which testosterone plays a role.” 

From around the age of 35, a man’s testosterone level typically declines by about one percent per year on average. “Early forties is a good time to be thinking about getting checked”, said Dr West.

“But I’ve seen younger men with really low testosterone levels. If you’re having symptoms, and especially if you’ve got risk factors for low testosterone, then you definitely want to get checked earlier.” 

The slow reduction of testosterone creeps up on men. There may come a tipping point where symptoms start to become more apparent, without any one obvious reason. 

It also tends to emerge at a time in the lives of men where family and career pressures become ever more onerous, including managing the needs of ageing parents. The accumulation of problems can occur alongside a daunting cascade of symptoms. Men might get close to the point of failure without noticing the onset of changes because they have been so gradual. 

“Although some are focused on prevention, most men tend to be less likely to seek medical help with issues they feel are minor. It’s only when problems get extreme that many tend to show up at the clinic,” said Dr West. 

“I sometimes hear from men who don’t really know what normal is supposed to feel like any more, because it’s been so long since they experienced it.” 

Dr West cautions against men jumping to the conclusion that they must have a testosterone problem. “I’ve had patients come to me, where they’ve done their blood tests online and a clinic has said, ‘Okay, we’re going to send you some testosterone injections’. Men need to be wary because you may well end up with a testosterone prescription that you don’t necessarily need.” 

Indeed, she points out that for some people there are risks that need to be explained or avoided, such as a potential risk of infertility.

“I’m seeing many men in their thirties who are already taking testosterone. We can see it in their blood tests. 

“And I’m sometimes not sure if anyone has told them that this could possibly make them infertile, if they’re taking testosterone at high doses for a long time, which can suppress your own testosterone production and your sperm production.” 

Dr West also mentioned prostate cancer: “Testosterone doesn’t cause prostate cancer. However, if you have active prostate cancer, testosterone can potentially feed the cancer cells, so this needs to be taken into account by your doctor.” 

Hormone doctors take a holistic approach in understanding the symptoms a patient might have. Dr West said, “It doesn’t always mean we have to use medication straight away, because there are always going to be risk factors to optimise first, like losing weight, doing strength training, improving nutrition and sleeping better. 

“We look for deep, chronic stress; this can make your testosterone drop even when you’re relatively young. Levels are also higher in summer compared to winter and it is completely normal for testosterone to drop when men are caring for their young babies.”

And what might start as checks for testosterone levels can sometimes pick up other important health indicators. Men don’t like talking to their doctors about erectile function but it is an important indicator of their cardiovascular health. 

“Loss of night-time erections and morning erections can be one of the earlier signs of heart disease risk, so that’s something to be aware of and to mention.” 

There is value in consulting a specialist in the field, added Dr West. “I recently attended a course for general practitioners (GPs) that discussed case studies describing how a GP prescribed antidepressants for their patients’ low mood and at the same time sildenafil (Viagra) for their erectile difficulty. And then in these case studies, the men just didn’t get better. The course was trying to educate GPs to say, ‘Look, if you had checked the testosterone in these men and treated them, that would have massively improved their quality of life’, but instead they were given antidepressants.” 

In general terms, Dr West has this advice for men: “Don’t rely on social media if you are suffering from symptoms. Get checked properly by a medical practice, not a service that only peddles hormones.

“Remember that an awful lot of these things are preventable by eating a good diet, exercise, strength training and avoiding alcohol and cigarettes. 

“Get as much outdoor, natural light as possible because that is like an essential medicine. Reduce chronic stress in your life, to the extent that you can, and by and large things will be better. 

“But get tested, if you have symptoms, because you might be deficient in testosterone. We can treat this.” 

This is what every man needs to know about testosterone: getting checked and seeking timely, expert medical advice could transform your health, your life and your capacity to be at your best.

Steve McCauley is a leadership coach, strategic advisor and journalist whose career spans media, government, digital technology and international development. A Senior Fellow at the University of Cambridge and certified executive coach, he has advised presidents, ministers, CEOs and global organisations on strategy, governance and creative thinking in complex environments. As Strategy & Creative Intelligence Correspondent for The European, he writes on leadership, governance, talent, innovation and the forces shaping European growth. 

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