Testosterone and Muscle loss in men.
Ninety-eight percent failure rate! Who would initiate something that had a 98% failure rate; let alone, repeat the failure over and over again? It sounds sadistic. It is the definition of insanity. But, that is exactly what Americans do with weight loss. With such a low success rate in the weight loss industry, one might conclude that there is little $$ value in the weight loss industry. That assumption would be wrong. According to the 2014 status of US market on the weight loss industry, the value of the weight loss industry was valued at $60.8 billion. That is $60.8 billion for a success rate of 2%. That makes the government look like a well-oiled, efficient machine—not!
Why do 98% of weight loss programs fail?
Do weight loss programs fail to help people lose weight?
The answer is no. Almost any weight loss program will have some preliminary success in weight loss–usually water within the first week. A prominent national weight-loss program that starts with Nutri and ends with System promises a 5 pound loss in the first week. That is 100% water. Is it weight? Yes. Is it fat? No. Actually, helping people to lose weight in the short term is quite easy. The difficulty and high failure rates come in with long-term weight loss and weight loss maintenance. Even the most dramatic means one can take to lose weight, bariatric surgery, fail to achieve successful weight loss in up to 30% of patients and many see a regain of 20-25% of weight lost. As if God forgot to bypass the stomach and that is the reason Obesity is at epidemic levels.
Back to the question, how does one explain the extreme failure rates in weight loss programs? The high failure rate of weight loss programs cannot be explained by just 1 problem—it is multifactorial. That being said, low muscle and/or muscle loss is a key component to the high failure rates seen in weight loss programs. This aspect of weight loss and weight loss failure is often lost on most people, including physicians. Every weight loss and healthy lifestyle strategy must include exercise. Everyone runs to cardio exercise as there first choice and if one is sedentary then cardio is a great first option. Most clients that we see at Seasons are already involved in regular cardio exercise programs. Don’t get me wrong, I am a strong proponent of cardio exercise. Many people just need to get moving. However, muscle building and its contribution to metabolism is forgotten. The ability to burn fat is concentrated in skeletal muscle. If an individuals muscle content is low to begin with and cardio exercise is the only exercise regimen prescribed (no resistance training), there will be little to no increase in muscle content. Cardio exercise does little to build muscle. Cardio does burn extra calories, but that ceiling is limited. Only resistance training and muscle building will promote more muscle and raise the ceiling of calories burned potential.
Muscle loss is a significant piece of metabolic dysfunction in both sexes, but especially in men. How is this possible when men carry more muscle mass compared to women? The term for it is called Sarcopenic Obesity. We see them daily. This is the classic man with belly fat, Man Boobs, small chest muscle, thin leg muscles, and thin arm muscles. The European Journal of Clinical Nutrition found the prevalence of Sarcopenic Obesity to be 43% in men compared to 18% of women in a study of 4,642 adults > 60. These men with sarcopenia have no capacity to burn fat; at best, a limited capacity. The metabolism of these men is severely under water. These men are literally drawing in a pool of fat without a way out. Any strategy to help these men lose weight and transition into a healthy lifestyle must include a strategy to build muscle. Any other strategy would be counterproductive and worsen muscle loss.
What does the evidence say about Testosterone and muscle?
The evidence on Testosterone and muscle loss is mixed. Few studies have actually shown a direct association between low Testosterone and muscle loss. Translated: low Testosterone in men causes muscle loss. This would be direct evidence of a cause and effect relationship between low T and muscle loss in. Though few, studies are present that point to a direct cause/effect relationship between low Testosterone and muscle loss.
Studies that point to a cause/effect relationship between low Testosterone and muscle loss include:
- Yuki A et al. Relationship between low free Testosterone levels and loss of muscle mass. Scientific Reports. Feb 20 2013;3(1818):doi10.1038/srep01818.
- Baumgartner, R. N., Waters, D. L., Gallagher, D., Morley, J. E. & Garry, P. J. Predictors of skeletal muscle mass in elderly men and women. Mech Ageing Dev 107, 123–136 (1999).
- Szulc, P., Duboeuf, F., Marchand, F. & Delmas, P. D. Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr 80, 496–503 (2004).
- Roy TA et al. Interrelationships of serum Testosterone and free Testosterone index with FFM and strength in aging men. American Journal of Physiology-Endocrinology and Metabolism. August 1 2002;283(2):E284-E294.
Testosterone, as it relates to muscle, is not created equally. There are several Testosterone measurements available:
- Total Testosterone
- free Testosterone
- bioavailable Testosterone
- Free Androgen Index
The measurement that has consistently been associated with low muscle/sarcopenia/muscle loss in men is a low free Testosterone . It is not that one measurement is better than another. One is not right and the others wrong. These are just different windows into the physiology of Testosterone. Each different view of Testosterone provides a different perspective. Each different perspective provides a different clinical relevance.
In contrast to the few studies that point to a direct cause/effect relationship to low Testosterone and muscle loss, the majority of studies on Testosterone and muscle have shown positive effects of Testosterone therapy reversing sarcopenia, building muscle mass, and improving body composition in men with low Testosterone . Studies that support Testosterone‘s role in reversing Sarcopenia in men with low Testosterone include:
- Kunihiro Sakuma and Akihiko Yamaguchi, “Sarcopenia and Age-Related Endocrine Function,” International Journal of Endocrinology, vol. 2012, Article ID 127362, 10 pages, 2012. doi:10.1155/2012/127362.
- Kovacheva EL et al. Testosterone supplementation reverses sarcopenia in aging through regulation of myostatin, c-Jun NH2-Terminal Kinase, Notch, and Akt signaling pathways. Endocrinology. Feb 2010;151(2):628-638.
- Axell AM et al. Continuous testosterone administration prevents skeletal muscle atrophy and enhances resistance to fatigue in orchidectomized male mice. Am J Physiology-Endocrinology and Metabolism. Sept 1 2006;291:E506-E516.
- Bebb RA. Testosterone deficiency: Practical guidelines for diagnosis and treatment. BCMJ. Nov 2011;53(9):474-479.
- Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010;95:2536-2559.
- Kapoor D, Goodwin E, Channer KS, et al. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2006;154:899-906.
Not a direct cause and effect relationship, that a decline in Testosterone results in muscle loss, but a consistent positive relationship that Testosterone builds muscle mass in men with sarcopenia. It is from these scientific findings that the inference that low Testosterone in men contributes to muscle loss is taken. Is this inference correct? The answer is yes–men with low muscle mass and low Testosterone will definitely benefit from physiologic Testosterone support. The result will be an increase in muscle mass. The positive muscle building effect of Testosterone therapy in men with low T will be greater in men with low Testosterone and normal muscle mass than men with low Testosterone and normal muscle mass. For the optimal muscle building effect of Testosterone, supportive protein intake and appropriate resistance training are also required to achieve optimal results. Testosterone alone won’t make you the next Arnold Schwarzenegger.
The answer to the question does low T cause muscle loss in men is a little more complicated. Low Testosterone is just one piece of the complex puzzle of muscle loss. Though studies exist to indicate low Testosterone can cause muscle loss in men, the majority point to Testosterone as just one piece of that puzzle. Is it an important piece? Yes, but it is just one piece for men.