Yes, LEOs are at an increased risk for Low-T. By the nature of police work, officers are frequently under both physical and mental stress. Stressful environments affect hormonal responses; specifically changes in testosterone (decreased) to cortisol (increased) ratios. Studies have found free testosterone values were significantly lower in policemen than in control groups. Additional risks for Low-T to law enforcement officers include poor sleep hygiene and nutritional habits secondary to shift work.
While low testosterone (low-T) can be dangerous to an officer’s health there is certainly associated risks with high levels. So do you have Low-T? How do you find out? If you do, what are your treatment options?
What is Testosterone?
Testosterone is the principal male sex hormone and the "original" anabolic steroid. It's the force behind his sex drive. The largest amounts of testosterone are produced by the testes in men. However, it is also synthesized in smaller quantities in women by the ovaries; by the placenta; as well as by the adrenal gland in both sexes.
Before puberty, testosterone levels are normally low. Testosterone is what causes boys to develop a deeper voice, get bigger muscles, boosts the size of his penis and testes, make sperm, develop facial and body hair. In adulthood, testosterone is what makes a man a man. Testosterone helps maintain men's: bone density, fat distribution, muscle strength and mass, blood cell production, sex drive, and sperm production. After age 30, most men begin to experience a gradual decline in testosterone, at the rate it has been established that testosterone decreases by approximately 1% per year. Low-T affects roughly forty percent of men over the age of 45.
Low Testosterone
Low serum testosterone (also known as hypogonadism or Andropause) is a disease in which the body is unable to produce normal amounts of testosterone due to a problem with either the testicles or with the pituitary gland that controls the testicles.
Symptoms:
- Changes in sexual function (reduced sexual desire, fewer spontaneous erections and infertility).
- Changes in sleep patterns. Low testosterone can cause insomnia or other sleep disturbances.
- Physical changes: including increased body fat, reduced muscle bulk and strength, and decreased bone density, swollen or tender breasts in men (gynecomastia), body hair loss are possible, and decreased energy.
- Emotional changes: decreased motivation and or self-confidence, feelings of depression, difficulty concentrating, changes in memory
It's important to note that some of these signs and symptoms are a normal part of aging. Other symptoms can be caused by various underlying factors, including medication side effects, thyroid problems, clinical depression other mental health disorders, sleep disorders, nutritional deficits and excessive alcohol use. A blood test is the only way to diagnose a low testosterone level.
Diagnosis of Hypogonadism
The only true way to determine low testosterone is to check the level of the male hormone androgen in the blood. Testosterone levels are highest in the morning. Blood for testosterone lab tests should be drawn between 7 a.m. and 10 a.m. Based on this blood test, your doctor must determine if your total testosterone level is low. To confirm a low reading, a second test on a different day is encouraged. Additionally, getting a second opinion from an endocrinologist is also suggested. Note: different laboratories measure total testosterone using different methods, thus there is no standard definition of “low” or “high). Additionally there is a large range of values that are considered normal.
Increased testosterone levels may mean:
- Androgen resistance (resistance to the action of male hormones)
- Cancer of the ovaries
- Cancer of the testes
- Congenital adrenal hyperplasia
- Early (premature) start to puberty
Decreased production of testosterone:
- Chronic illness
- Condition in which the pituitary gland does not produce normal amounts of some or all of its hormones
- Delayed puberty
- Failure of the testicles
Testosterone Replacement Therapy (TRT)
TRT can help reverse the effects of hypogonadism. Testosterone replacement has been shown to improve a man's energy, libido (sex drive), muscle mass, sleep, erections, energy level, and depressed mood. It also decreases body fat. Additionally, it may increase their bone mineral density and decrease the risk of fractures. It is important to realize that testosterone treatment is considered lifelong therapy, just like in other chronic conditions.
If it sounds too good to be true….it usually is.
If the sole reason that you are considering taking testosterone is to help you feel younger and more vigorous as you age you need to be aware that there are risks. Testosterone is not the fabled fountain of youth that mankind has searched for eternity!
Testosterone therapy MAY include the following risk factors: worsening sleep apnea (a life-threatening condition), increase in the platelet count, (which could increase the risk for blood clots), increase risk for both stroke and heart attack, a cancer, lower sperm count, an cause acne or other skin reactions, enlarge breasts in men, testicle shrinkage, increase in the size of the prostate, and water retention. While there have been some randomized controlled trials of testosterone therapy, the longest has only lasted 36 months. We need a large study with multiple thousands of men followed for many years to figure out if the benefits outweigh the risks.
Options Available for Testosterone Replacement:
- 70% use testosterone gels that are applied daily to the shoulders, upper arms, or abdomen.
- 17% use intramuscular injections, generally every two or three weeks
- 10% use testosterone patches worn either on the body or on the scrotum (the sac that contains the testicles). These patches are used daily. The body patch application is rotated between the buttocks, arms, back or abdomen.
- 3% use long-acting implantable pellets, oral, or inhalation therapy
Law Enforcement Officers and Testosterone Replacement Therapy
If you have Low-T and are an officer, what are your options related to your department? There does not seem to be any standard protocol between law enforcement. The bottom line (from what I have been able to ascertain through online research) is that the officer needs to be able to provide evidence that he has obtained a legitimate prescription from a reputable and knowledgeable physician, for a medically necessary condition (usually hypogonadism). A fitness-for-duty evaluation is usually required to ascertain whether the officer is using (or abusing) the steroid that could in any way jeopardize public safety. The standard treatment of hypogonadism is the use of a testosterone patch or gel (both of these methods unlikely to be abused). Steroid abusers more commonly use injectable preparations.
Additionally, tests will need to be given regularly to make sure that levels are within the therapeutic range. Research suggests that individuals taking in excess of 100–200 mg of testosterone per week are outside the bounds of therapeutic use. Additionally, a dose of 300 mg of testosterone per week individuals are more likely to exhibit aggressive behaviors; and these behaviors begin to take place more frequently. There are obvious liability issues for the department related to critical incidents with an officer who is abusing any steroid. Remember: testosterone is a Level III scheduled drug.
Oh, and by the way, if you exercise a little more, lose a couple pounds and eat more healthfully - there’s clinical evidence you can raise your testosterone naturally. Feel well.
Pamela Kulbarsh
Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.
