DALLAS — Greg Lucas wasn't feeling at the top of his game. He'd gained weight, and the machines at the gym filled him with apprehension.
"Sex wasn't tops, but that wasn't the problem," he says. "I felt tired. I was dragging myself around."
Lucas was then 25 years old. He decided to go and see his doctor. "They did a blood test, measured my testosterone level," he says. "I was in the lowest 5% for a man of my age, but the doctor refused to prescribe testosterone. I let it drop, but I still felt drained."
Three years later, this respected software company executive was talking to a friend who praised the miracles of testosterone injections. This time, Greg didn't go to his doctor but to Total Med Solutions in Dallas, where they recommended he take the hormone. He now goes in every two months for an injection and supplements those with a self-injection every 10 days. The treatments cost him about $315 (250 euros) a month.
Greg is now 31 years old and has been taking testosterone for three years. He shows us his thigh, as thick as a tree trunk. "I give myself the shot in the quadriceps. In view of its size, it's not a problem."
It must be said that Greg is huge, a mountain of muscle weighing 315 pounds (143 kilos), capable of lifting double his weight. He dreams of winning the competition for "the strongest man in the world" (he finished sixth this year, for Texas). Is that thanks to testosterone?
"That's what gave me the energy, the desire to go to the gym. I feel like a million bucks."
Hulks all over the U.S.
He's not the only one. Last year 2.3 million American men took the miracle product, and consumption among men aged 40 to 50 has quadrupled since 2000. An epidemic of diagnoses of hypogonadism, when the testicles don't produce enough testosterone, partly explains the trend. A decrease in testosterone is a natural phenomenon among aging men, decreasing about 1% a year starting at age 40.
Hypogonadism, on the other hand, is rare. Or rather it was before 2000, the year a lab launched AndroGel, a testosterone gel that is applied to the shoulders. In a stroke of marketing genius, the lab doesn't mention hypogonadism, but simply "Low T." Are you tired? Low T. Is your sex drive not what it might be? Low T. Do you often feel sad or depressed? Low T. Do you doze off right after dinner? Low T!
"They brought a new definition to a medical problem," says John Mack, a specialist in pharmaceutical marketing. "Nobody had heard of hypogonadism, but "Low T" clicked. And practically any man over 40 who took one of the tests they suggested could tell himself he had "Low T.""
The birth of Low T Centers
At Southlake, near the Dallas airport, black coupes with big tires vie with muscle cars in the Low T Center parking lot. This is where the era of Mike Sisk began in 2009. Sisk has an incredible gift of the gab and has always been in sales — first at FedEx, then in finance.
"But by the time I hit 40, my batteries were run down," he explains. "I didn’t have any energy, couldn't drag myself to the gym. I felt as if I were living in a permanent fog."
Desperate, he had his doctor prescribe testosterone.
"After one month, a miracle! My life turned around. But my wife had to give me the shots, which was neither practical nor agreeable."
Hence the idea for the Low T Center. When you walk in, a smiling receptionist leads you to a waiting room equipped with a giant TV set to a sports channel. On the wall are jerseys signed by American football stars.
The atmosphere is very "man cave," the opposite of a typical clinic. Soon the client is taken to a room where a blood test is conducted.
"A doctor will tell you "come back in a week,"" Sisk says. "We process the test in a half hour." He shows us the lab where testosterone levels are tested along with cholesterol and proteins produced by the prostate.
If the patient has a testosterone level under a certain threshold and presents symptoms of hypogonadism, he can start treatment: A visit every 10 days and a blood test every 90 days for $400 (300 euros) a month, generally covered by health insurance. "We turn one in two candidates away," Sisk says. "By the end of this year, we'll have 60 Low T Centers in America, and double that by the end of 2015."
Bill Reilly, the medical director at Low T, believes the potential is enormous. "Nowadays men of 60 want to feel like they're 40," says the former surgeon with impressive biceps for a man in his 60s. But he adds that "testosterone won't take care of your weight issues if your ass is glued to your chair."
Reilly became a fan of the hormone supplement after treating patients. Brian, 36, is another fan, a father of four whose job in real estate is "more stressful than ever." He started treatment at the Low T Center six months ago.
"My wife wasn't sure about it," he says. "She was afraid I'd turn into a sex fiend. She was also afraid I'd get aggressive with the kids."
Those fears turned out to be unfounded, though Brian seems to understand that the injections don't come without some down side. The administration of testosterone, for example, stops natural production of the hormone, so the effects of stopping it can be severe.
A divided medical community
Testosterone supplements also have advocates in the medical community. Abraham Morgentaler, a professor of urology at Harvard Medical School, discovered the benefits of treatment with the hormone as early as the 1970s when they were reserved for extreme cases such as ablation of the testicles. For him, there is no doubt.
"There are a great many men who reach mid-life and don't feel the way they should," he says. "Sometimes the cause is medical, like a low level of testosterone, so to give them treatment for three or six months is perfectly reasonable."
"The ones who think that a low sex drive is not serious enough to warrant treatment have a terrible attitude," he continues. "I've seen thousands of men in my practice, and when they have sex problems they are profoundly affected."
But other doctors, with just as fine a reputation as Morgenthaler, are more critical. "These Low T Centers are just there to make money," says Edward Karpman, a urologist in Silicon Valley. "They're not specialized. Testosterone treatments can be beneficial for many men, but they have to be done under strict supervision."
That's particularly true because the issue of potential negative side effects is far from clear. Fears of increased risk of prostate cancer have receded, but cardiovascular risk is still being hotly debated.
In Los Angeles, a team working with William Finkle, who heads Consolidated Research, published a study based on a 56,000 men. It concluded that the risk of heart attack for men taking testosterone doubles in the 90 days following the start of treatment. The study and its methodology unleashed much criticism, but Bill Finkle is sticking to his guns.
"We looked at what happened with 7,000 men of 65 or over before and after their first testosterone prescription," he says. "The year before the prescription, the incidence of infarct was 5 in 1,000. In the 90 days following the start of treatment, it had climbed to 11 in 1,000."
Jacques Baillargeon, a researcher at the University of Texas, has seen results no less alarming. But he acknowledges that "there is no wide consensus on what hypogonadism is and from what level of testosterone treatment would be warranted." The Food and Drug Administration recently held a meeting of experts to debate labels and more restrictive guidelines.
"These treatments are new," says Eric Bricker, a urologist in Dallas. "We should wait four or five years before prescribing them so widely."
Says Greg Lucas, "Others can do what they want. To each his life. I have no intention of stopping."