The Bearable Lightness of Low-T

Back in simpler times, doctors might have told their older male patients that the most likely cause of their malaise was nothing a little man-to-man conversation with their peers over brandy and cigars couldn’t cure.  Nowadays, doctors peer into a computer screen at a bank of numbers and pronounce judgment on a patient’s general state of health with more assurance of being right than a phalanx of Ivy League economists, armed with a stack of charts and tables, predicting next month’s employment figures.  In my case, the number under consideration was my testosterone, which was so low that when my doctor mentioned it, a treble of disbelief escaped his lips in the form of a low whistle.  When he looked up, there was a brief flicker of surprise in his eyes, as if he’d expected to find me slumped on the floor.  “Have you ever tried to dribble a deflated basketball?” he asked.

I had just spent a few days before my visit scouring the Internet for a deal on a used whitewater kayak, and this was not a question I wanted to hear.  For it was not, of course, a question about my basketball prowess, but a declaration of war against the declining powers of what, for lack of a better word, is called manhood.  Yes, mine.  And, yes, I know, manhood is a sometime euphemism for the male reproductive organ; more generally, it helps us tell the difference between NFL linebackers and English professors like me.  But I took it literally, or at least literally enough to picture a depilated, atrophied shell of a former man, looking every year of his three score and three, sprawled across the free-throw line like a flung-away gym towel, the word VOIT stamped across his forehead, the T tending in shape toward a D.  I am in decline.  The number, almost too weak to cling to the screen, says so.

Testosterone is produced in the testicles, though the amount that’s actually delivered into the blood stream is regulated by the hypothalamus and pituitary gland.  Like almost everything that goes on in the body, the process is controlled by the brain, which signals the testicles to go to work, or to suspend operations, as need and circumstances dictate.  When the system is working the way it’s supposed to—when, that is, the amount of testosterone in the blood comes in at between 300 and 1000 nanograms per deciliter (ng/dl)—then a startling and rare phenomenon occurs: the male sex organs are actually listening to what the brain is telling them.  Mine, apparently, were in open rebellion, chemical-wise.  I was mired a few clicks south of 200 ng/dl, which means I should have been staggering into my doctor’s office like an old prospector who’d been lost in the mountains and couldn’t remember where he’d tied his mule, utterly uninterested, even after months alone in the wilderness, in worldly pleasures.  But all things considered, I was feeling fine.  I got a little tired in the afternoons, and sometimes I gave in to a short nap, but usually a vigorous bike ride and a power bar were sufficient to punch through the three o’clock doldrums.  More importantly, my wife’s complaints were in the range of the usual: Isn’t it about time I changed the oil in that t-shirt I’d been wearing for three days?  And what about the batteries in the smoke alarms.  And the front yard is starting to look like a Nebraska corn field in July.

Abysmally low-T is not the end of the world, unless you’ve just married one of the Kardashians, in which case the ship of matrimony is already foundering.  The hatch could swing shut at a moment’s notice.  Nor is it the kind of news that will give a wife or partner cause for alarm (and it might answer a question that’s been nagging them for months on end).  It’s provided the spark to the gunpowder of many a proctologist joke, a genre of humor that seems to have begun with Johnny Carson.  Nonetheless, when it comes to aging, we baby boomers are short on humor and long on fixes, and in our opinion there is nothing good about that night we are going ungently into.  We guys are known for doing crazy things, like riding motorcycles or developing a sudden interest in extreme sports; the midlife crisis, if it’s been delayed a decade or so, takes the form of a subscription to Men’s Journal and lingering, lustful gazes at a Dagger Mamba 8.1 kayak, accompanied by heavy breathing and palpitations of the heart.  In one commercial, a buff older guy in a tight-fitting t-shirt—the resemblance to Marlon Brando or James Dean seems deliberate--pops a Viagra (since you asked: no) and then, by himself, drives his vintage Camaro, top down and unmuffled, deep into the Mojave Desert, Howlin’ Wolf’s “Smokestack Lightnin’” playing in his head.  Like all of the commercials for erectile dysfunction, this one is more style than substance: there’s no tension to speak of, the narrative arc dissipates about five seconds in, and a great car and a blue pill go to waste.  But the guy looks like he could plant smiles in a single weekend up and down the Pacific Coast and still get in a round of golf.  That’s the message the commercial is selling.

Before we baby boomers admit the inevitable, it’s off to the pharmacy we go, prescription in hand, in my case for a bottle of pump-activated Axiron.  The very name conjures bare-chested, loin-clothed beefcake actors speaking dubbed English in 1950s Hercules movies.  I promise, I’ll keep my shirt (clean) on and stay clear of stables, but I’m no less caught up in the vanities of my generation than the square-jawed, steely-eyed sexagenarian in the commercial, and I would like to keep my sinews strong enough to draw the bow for a few more years.  Sixty three is thirty.  At seventy I just might pick up and follow Muddy Waters’ advice and go to New Orleans to get my mojo working.   My wife would love the Crawfish Etouffee at Drago’s.  The Me Generation is but a feather landing softly to our vigorous stomp upon the earth, and Generation X is the fragile scree left behind by our glaciated advance across the landscape of time.  I am man; hear me belch above the pulsating roar of a V-8.

But according to one student of the condition, a fitness writer named Lee Myer, who blogs at peaktestosterone.com, low-T is the gateway to a life flat-lined by every conceivable malady, mental and physical, to which the human male is prone; it is a slippery slope, deceptively gentle at first, that ends in a droopy existence devoid of all signs of life and is relieved only by a long, slow, foot-dragging limp to an early and submissive death.  Among the symptoms of low-T, which “can also fool a guy because they are so ubiquitous,” are “depression, mental fogginess/fuzziness, difficulty concentrating, anxiety, loss of muscle, increased weight gain, decreased facial hair and a general feeling of not caring about anything.”  Yes, these are, like, soooo ubiquitous, but guys are just as easily fooled by the rare and remarkable.

Included in that not-cared-about anything, it should come as no surprise, is sex.  Mr. Myer most definitely does not wish to be counted among that fraternity, for the pains he takes to tell us how deeply he cares about sex are truly extraordinary.  “Of course,” he writes, those two little words performing above and beyond the rustic duties of transition, “the number one thing in most guys' mind is how it [low-T] affects their sex life.”  I don’t have a clue to what that thing might be, but, whatever it is, there is only one of them, as well as only one mind to contemplate it, and in the next sentence we are told, for the second time, that the scarcity of sexual commodities extends to…well, let’s hear Myer explain it: “Low testosterone affects both libido and erectile strength to varying degrees and that obviously isn't too good for the ol' sex life” (emphasis added).  No, it is not, although I have no personal knowledge to verify this, but what gets me is that it appears that there is only one of those ol’ sex lives to go around for the entire male population.  What an abominable pity.  One thing, one mind, one sex life: Myer is coming very close to saying that low-T is the natural condition of all men and that we are disturbing the balance of the universe with our pumps and our creams and our dietary supplements.

Myer is the author of two e-books on erectile dysfunction.  (The online Merriam-Webster dictionary gives two definitions of dysfunction: 1. “impaired or abnormal functioning,” the example given being “gastrointestinal dysfunction,” which, I’m sorry to say, confirmation-wise, is ubiquitous among my generation; and 2. “abnormal or unhealthy interpersonal behavior or interaction within a group.”  Oh.)  In the interest of full scholarly disclosure, I present the books’ titles, without a word left out or any missing punctuation marks silently added: Peak Erectile Strength Diet: Become an Orgasmatarian [sic] Let Science Improve Your Hardness Factor Through Diet, and 15 Natural Erectile Dysfunction Cures: Research-Backed Solutions to Troubleshoot and Heal Your Erections.  The thought of troubleshooting an erection bothers me somehow, but apart from this, what else can we conclude from these titles?  I think it’s that Mr. Myer has watched a lot of 1930s B-grade movies about mad scientists.  (Can anyone forget Edward G. Robinson’s scene-stealing portrayal of the criminal mind in The Amazing Dr. Clitterhouse, which includes Humphrey Bogart in the role of, I swear, Rocks Valentine?)  Like all books published in the United States, PESD and 15NEDC will find their way to the shelves of the Library of Congress, and I think I’m on safe ground in saying that more than a few of our legislators in Washington will read them with keen interest and a common purpose.  I’ll bet Myer gets invited to a lot of parties.

Axiron is self-applied to the axillary fossa, which is bounded laterally by the coracobrachialis, located at the upper part of the arm where the biceps brachii and triceps brachii join, and medially by the serratus anterior, found at the upper part of the coracoid process.  The instructions that come with Axiron call this the armpit.  (In Great Britain and Ireland, the word is oxter, whose origins appear to be Celtic, which may suggest that the armpit was once the site of a potent magic that has been lost to all but those few who have been initiated into the craft).  The actual applying of the stuff is unproblematic.  You squirt a little into the rubber cup, raise your arm, lean over the sink (you’ll spill some), swab until the cup is empty, wait a few minutes for the application to dry, get dressed, and off you go.  If you know how to apply deodorant, you can have yourself a ball with Axiron.

But don’t have too much of a ball, even if you’re taking the stuff for precisely that reason.  Side effects include lower sperm count, swelling (especially at the feet and ankles), sleep apnea, and blood clots in the lower extremities.  Men who take large doses (well in excess of the 60 mg /day maximum prescribed dosage) might grow breasts.  Their PSA (Prostate Specific Antigen) might skyrocket, potentially indicating benign prostate hyperplasia (BPH) or cancer.  Under no circumstances should the product get into the hands of children.  Do not apply it before, the instructions delicately put it, “intimacy” with another person.  Unquestionably, the most embarrassing—particularly if you ride crowded buses a lot—and, I would imagine, supremely uncomfortable, but thankfully rare, side effect would have to be priapism—frequent and prolonged erections.  There are urban legends handed down since the fifth-century that Atilla the Hun died during a night of rough sex with his new, and seventh, bride, after an evening of heavy eating and drinking.  The official cause of death is given as a nose bleed, possibly inflicted by his beleaguered spouse, who may have been armed with a knife, and his subsequent drowning on his own blood.  A second theory points to esophageal varices, caused when high quantities of alcohol dilate the sub-mucosal veins in the lower third of the esophagus to the point that they rupture and the victim hemorrhages to death.   Priapism is implicated in the first cause, but distantly, and is statistically relevant in the second, for it is known that 21 percent of cases of priapism are associated with alcohol abuse.  By whatever cause, it sounds like the bastard got what he deserved.

Before there was Axiron, before there was Viagra, before there was supplemental DHEA (dehydroepiandrosterone, a substance that aids sugar metabolism), there was Mr. Reese, my tenth-grade health teacher.  His remedy for low-T was, I’m pretty sure, an artfully disguised memoir of his college-day love affairs.  I remember him as a tall, suave man, nattily dressed, with a trim figure and a surf wave of red hair flecked with gray.  It embarrasses me to say this—I was sixteen at the time—but it is possibly from Mr. Reese that I learned for the first time that a boy and a girl could do more after a movie than walk home holding hands.  This would have been in 1965.  The Women’s Movement was well into its second wave; two years before, Betty Friedan had published The Feminine Mystique, a fact unknown to us teenagers and apparently a matter of supreme indifference to an operator like Mr. Reese, for his remedy sounds like it came straight out of the Playboy Advisor.  (I can say this now, out of a concern for historical accuracy.)  I don’t remember his exact words—poor memory is one symptom of low-T—but they went something like this: “If you want to get a girl in the mood, put on some soft music and dim the lights.”

He delivered this to a class of all boys.  I can’t imagine what his colleague, Mrs. Darby, who taught the girls, was saying.  I would not give anything, but I would give more than the change in my penny jar, to have overheard their conversations in the faculty lounge.  To give his advice the necessary rhetorical kick, Mr. Reese glided imperiously from behind his desk to a spot beside the lectern.  Behind him, on the chalkboard, were diagrams, poorly drawn but graphic.  All snickering stopped when he glared at us.  A reverent hush fell over the room.  We were in the aura of a man in possession of vast experience with the mysterious ways of women, the mere thought of which had us swimming in pools of saliva, of forgotten and esoteric knowledge of the arts of love-making, for if anyone knew more than one, it was he, and he was about to deliver the hammer blow of truth.  Leaning against the lectern in a pose of courtly insouciance, he interlocked his fingers, rested an elbow casually on the lectern’s surface, and spoke in an earnest, measured tone, like a Scout Master lecturing on campfire safety.

I have no idea what Mr. Reese’s tastes in music were.  I picture a cabinet stereo in his dorm room with half a dozen albums spread out on the floor, but not where they are likely to get broken in the ensuing mayhem.  They have titles like For Lovers Only and Seduction by Candlelight, and the dominant colors on the cover are the wine red of satin sheets and the velvety yellow of a candle’s flame.  For lighting, a Coleman camp lantern glows under a pillowcase on a rickety card table.  Such are the rituals of blossoming manhood.

And thus the wise and ancient Mr. Reese, Socrates to our hormone-addled Phaedrus.  Right.  Romantic music.  Soft lighting.  Maybe a silk robe loosely tied at the waist.  To a tenth grader the sheer logistics of the thing would have been insurmountable—one did not simply give his parents fifty dollars and tell them to go out and have a good time--and ten years later, when we were married with kids, the logistics were laughably impractical.  Public school education, then as now, was geared toward making students pragmatists anyway, so our interpretation of Mr. Reese’s remedy was by necessity instrumentalist.  Romantic music equaled The Four Seasons’ “Candy Girl” on the dashboard radio; soft lighting came from the flashlight in the glove box of our father’s Pontiac.  There was little subtlety involved, or required.  If the cops put an early halt to the proceedings, a sheepish smile, a profusion of humble Yes, Sirs and No, Sirs, and a hasty but fumble-fingered rebuttoning of garments were generally sufficient to get you home early, with only a warning, in time to take a cold shower (also recommended by Mr. Reese) before bed.  I have a son who’s a cop, and he assures me that most of them remember when they were young.

A few months before he died, my father, a man with a waggish sense of humor to the very end, told me that he had a theory to explain how he came down with prostate cancer.  He was mindful, I think, that if he didn’t tell someone before it was too late, the truth would expire with him.  By then the cancer had invaded virtually every corner of his body, and he was confined to bed, too brittle and weak even to lie propped up on pillows.  The best he could do was talk for a few minutes on the phone.  His wife, my stepmother, would hold it to his ear.  Even under those conditions, even with the undertaker practically parked in his driveway checking his watch every few minutes, my father knew how to tell a good story, and as far back as I can remember he always got me to believe them.

He had dated a girl in El Paso, when he was in the army, and adopting a strategy of narrative indirection he made it pretty clear me that his transition from adolescence to adulthood had involved more than enduring the stresses and indignities of army life.  He then referred me to a photograph, which my stepmother later gave to me, of him and three army buddies and the girls they were out with, taken in September, 1944, on a night out in Paris.  The eight of them are sitting around a table in a crowded night club, drinks in their hands, empty glasses spread out all around them.  Everyone is laughing, but it is the women who are laughing most of all.  Their whole bodies seem to be laughing, as if liberated from some restraint in their lives and allowed to think that, at last, the promise of a brighter and unencumbered future might be kept.  And who better to laugh with than four American soldiers who came calling with liberation, and with chocolate and nylons and condoms.  Alone of the four women, my father’s girl is sitting in his lap, her arms draped around his neck.

“Well, dad, you were young, you were a soldier, you were overseas, and you were going off to battle.  And it was Paris.  But what’s that got to do with getting prostate cancer?”

I heard his chuckle through the earpiece.  “Well, they say men who have sex regularly are less likely to get it.”

Okay, I thought, I’ll keep that in mind.

“I suppose you want to know what they mean by ‘regularly’,” he added.

“Not particularly,” I said.

“Good, because the answer won’t do me a damn bit of good anymore, and it’s not the kind of advice a father should be giving his son.”

That was reassuring, I told him, what with twenty years of marriage and three kids behind me.  Then his voice turned serious.  “But I will tell you this.”  He was silent for a moment.  “No matter where you are or what you’re doing, if you have to take a piss, do it.  Don’t hold it in.  Just go.  I think that was my mistake.”

What?

Here’s how he explained it.  As part of the training for the rigors of combat, the drill sergeants wouldn’t allow the men to relieve themselves.  My father told of how, after working outside all day in a cold January at Fort Dix, New Jersey, where he took basic, the whole company had warmed themselves with cup after cup of coffee.  My father liked his coffee strong, without milk or sugar, and he drank it by the quart.  After the evening meal, and still more coffee, they were made to stand at attention out on the concrete expanse of the parade grounds.  One hour passed, and then another, and then another.  Traffic on the highway gradually subsided; lights in homes and businesses one after another winked out.  And as the night dragged on and the silence grew deeper and the temperature fell, one-by-one the men began to crack.

“God, I gotta go.”

“It feels like there’s a razor blade in my bladder.”

“I’m gonna shoot that bastard, Sergeant Walinski, and then I’m gonna piss all over his body.”

By three o’clock in the morning, the complaints and imprecations directed at Sergeant Walinski, at the army, at the United States, the Nazis, and the gods had been replaced by loud groans and a few genuine screams of pain and the sound of men hitting the concrete.  By dawn fully half of the men were writhing in pain on the ground like snakes struck by lightning, and the rest, my father among them, were actually hopping from one foot to another.  But not a single one had peed as much as a drop.

Like almost all soldiers, my father took what he had learned in the army with him into civilian life, including this regimen of urinary self-discipline.  He adhered to it his entire adult life, until, he was convinced, it was too late.

A son does not argue with his dying father.  There is, so far as I know, nothing in the medical literature to support my father’s theory, but I just had to know.  Prostate cancer killed him; his older brother, my uncle Dan, survived it.  (In fact, he lived another ten years after his prostatectomy and then died in an automobile accident.  His wife was at the wheel.)  This automatically places me in that population of men who are three times more likely to get prostate cancer than men who don’t boast the family history I have.  My doctor, it turns out, is in the same risk population as I, and, like me, he is on Axiron, and Axiron, essentially bottled testosterone, elevates that risk even more, if only slightly.  Restoring one’s manhood, it appears, comes with a price.

When I mentioned my father’s theory to my doctor, he shook his head.  “There’s no connection.  The only reason to piss is that it’s damned uncomfortable if you don’t.  The trouble is, with us old guys, we just have to go more often.”

Like me, he’s a whitewater enthusiast, and before I left he told me that he had recently bought a Mad River Legend 15 canoe.  In skillful hands, it’s capable of navigating the moderate rapids so common to rivers in the Southeast and that can fool even the experienced paddler.  About the same time he bought the canoe, he began taking Axiron.  Among other things, he joked, it has improved his paddling skills.

“Next to marrying my wife, getting that canoe and going on Axiron are the best decisions I ever made.”

I mulled this over.  “That settles it.  I’m getting a Dagger Mamba 8.1.  See you on the river.”

“Now you’re talking,” he said.  “But you still have to take your Axiron."