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To Your Good Health: Testosterone Has Legitimate Uses, but Use Caution

Dear Dr. Roach: Could you help explain the preponderance of testosterone-enhancing drugs that I see advertised lately for “low male libido?” Do they contain anabolic steroids, and if so, shouldn’t they be prescribed under the strictest medical supervision and for reasons other than “low male libido?” — L.R.

Answer: It depends on which type of advertisement you’re referencing. There are two.

The first is the actual prescribed testosterone, which used to be given only as an injection but now can be prescribed as a gel that is absorbed through the skin.

Testosterone is an anabolic steroid (“anabolic” means that it promotes growth), and as you suggest, it has the risk of side effects, especially when abused and taken in high doses. One major theoretical risk has been of prostate cancer, so “strict medical supervision” — with which I heartily agree — should include evaluation for prostate cancer, despite preliminary results that point toward there not being much risk. Other potential risks include an increase in red blood cells, occasionally high enough to cause a stroke. That’s why it’s considered a controlled substance by the Food and Drug Administration.

But what you may be thinking of are the many advertisements for nonprescription supplements that are touted to increase the body’s own supply of testosterone. I’ve reviewed several of these and have found scant evidence that they increase testosterone, improve libido, help build muscle or strength, or have any other benefits compared with a placebo.

I think that prescribing testosterone for decreased libido is reasonable. Sexual health is important, and properly used, testosterone is effective for many people (but not everybody) and has few risks. However, as always, I feel strongly that everyone should know both the risks and benefits of taking a particular medication before starting it. Some men will be willing to take the risk; others won’t and shouldn’t.

Dear Dr. Roach: I had an abnormal blood sugar reading of 111, where the normal range is 65-99. My primary care doctor has been monitoring it and doesn’t feel it to be of concern. What can I do to bring the number down? I take folic acid daily with other vitamin and mineral supplements. I’ve had cinnamon recommended by friends who have had success. Is this something you’d suggest I try? — J.M.

Answer: We in North America are in an epidemic of diabetes, and many people with diabetes aren’t yet aware of it. As doctors do more screening, we find people with abnormal blood sugar but who aren’t diabetic.

First of all, 111 is a very abnormal blood sugar level if you had been fasting, but it’s a normal blood sugar level two hours after eating. Both fasting and nonfasting levels can be used when looking for diabetes, but the ranges of normal are different. The normal range you gave was for fasting.

Second, the two most important factors that decide whether a person with a predisposition for diabetes will actually get it are diet and exercise, and these are where I would most recommend making changes. The big problem with dietary choices is sugar — simple sugars especially, but even complex sugars like starches predispose one to diabetes if taken in excess. Natural sugars, such as what’s found in whole fruit, are much less of a problem than fruit juices, sodas or sweetened processed foods.

Exercise is a powerful way to reduce blood sugar and diabetes risk. It doesn’t have to be extreme exercise — even a half-hour walk per day can begin to reduce blood sugar, especially when taken after eating.

Cinnamon does have the ability to lower blood sugar in people with type II diabetes. As little as 1/4 teaspoon twice daily reduced blood sugar about 20 percent. However, I still recommend healthy exercise and low sugar for almost everybody.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.