If you find yourself with these symptoms (and even if you don't - see below for why), whatever your gender, get your testosterone level checked. We've known for decades that low testosterone causes fatigue and brain fog and the treatment for it has been approved for medical use for over 80 years, but you can go to doctor for "long COVID" and they'll do a blood test for a huge list of things and ignore testosterone, as does this article. If you want it checked you'll probably need to push for it and/or pay extra. There's a stigma around it and it's a controlled substance, but some people simply need it and will not feel normal without it.
There's a persistent myth that testosterone production in men falls as a natural part of aging. The truth of what happens to "normal" levels with age is more complex [1] but what is known is that in some people testosterone production falls dramatically and permanently at some point at some point in their life, sometimes after an injury or infection, sometimes for no discernible reason, and it can cause exactly the symptoms described here. When that happens it's not a "male menopause". It's not normal aging. It's pathological and it's treatable. The reason to get your level checked even if you don't have symptoms is so you know your personal baseline and can tell if a sudden change happens later.
The situation in women is more complex, and testosterone treatment carries different risks, but androgens are very much part of healthy female hormone production.
It's early days but there's been some interesting research about a possible mechanism for permanent changes in androgen production after COVID [2].
I'm not saying this is the only cause of long COVID. There's certainly more than one mechanism, and what helps one person can harm another (as with the graded exercise program mentioned in the article, which was entirely counterproductive for me). But it is one of the possibilities and if it were routinely checked for in people reporting these symptoms it would have spared me a few years of hell.
Viral infections and stress can cause multiple hormonal issues, from testosterone to insulin to thyroid, out of which a lot will be skipped or only a partial picture will be given during average blood test (i.e. just total test or TSH).
Unfortunately, most docs will just skimp over the results or tests to be done, so the things like "I'm tired a lot" just get handwaved away. (Un)Fortunately, a lot of friends brought their blood tests results to me since I've spent quite a long time biohacking, and nearly always it was the same: the doctor didnt do a full panel but just a partial one, said something is okay or mid, when it turned out that a full panel indicated a much bigger issue. Hell, one of them would even fall unconscious nearly once a month and multiple doctors said "it's just stress" when it turned out the person was hypoglycemic and their sugar and blood pressure would crash.
Would you mind sharing the full list of tests that you personally consider important (for men, in my case), or which you think constitute a "full panel"? I would like to be explicit about it when I get one.
I assume the "defaults" vary from country to country, and as you say, from clinic to clinic.
If I were to guess, HN doesn't like your comment because it feels like a certain type of manosphere article. Some sort of cross between self-improvement and advertisement, offering a potential quick fix. Includes a "the masses don't know this, but here is the truth" kind of thing.
I guess that's the "stigma" I referred to. It's not very rational, though. To view it as "self-improvement" would be to not take the symptoms seriously, and I would hope as a society we've moved past that. As for a "quick fix" - well, for some people (certainly not everyone) it is that. It's not without its downsides, though. I'm going to be injecting myself for the rest of my life, a commitment I underook with my first dose (as natural production ceases, so coming off it is not easy). There are major concerns for fertility too, for those to whom it matters
As for "advertising", I don't stand to gain anything from publicly and pseudo-anonymously sharing my experience of a medical treatment. If anything there are risks to doing that.
And as for "the masses don't know this", it's more "your doctor probably won't test you for this". Look up the symptoms of hypogonadism, compare them to those described in this article and observe that the article makes no mention of it. If you know someone suffering these symptoms, and most people do, see if this diagnosis has ever been considered. The answer is probably no.
It's not grey now as it's been voted back up, but it went down to -3 in a few minutes after posting, by far the strongest negative reaction I've had to a comment.
> It's not grey now as it's been voted back up, but it went down to -3 in a few minutes after posting, by far the strongest negative reaction I've had to a comment.
I've long suspected there's some kind of automation going on. I've written a number of inoffensive comments that shouldn't really cause a reaction from anyone, but the score goes down, then back up over a short period. Not sure why there would be an algo for that, but it feels like it.
The cultural left is becoming increasingly like the right in some ways and I’m not sure how I feel. On one hand, this might be helpful because the imbalance between a restrained left and an obnoxious right has been pushing the Overton Window in conservatives’ favor for decades and I’d be happy to see that stop. On the other hand, it upsets me to see other leftists be misinformed. Low T is a real health problem for a lot of men—-this isn’t manosphere bullshit.
I stopped calling myself a liberal in the 90s because I went to Europe for business a lot and liberal, funny enough, means conservative over there. I never really felt progressive fit—-too moderate, because it assumes all you have to do is sustain progress, but that speed isn’t crucial. And I am still on the far left but I feel less at home on the left since the shamefully misinformed reactions to the Simchat Torah massacre. I don’t support Israel’s far right government, but most of the people murdered didn’t either, and watching high school kids in Palo Alto chant a literal genocidal slogan was a wake-up call.
Watching high school kids in Palo Alto chant a literal genocidal slogan was a wake-up call.
Except most likely it wasn't. An actual, "literal" genocidal slogan, that is.
The simple, boring fact is -- whatever import along those lines (that you see in whatever they were saying) probably wasn't what they intended it to have.
Most of the ones using it are simply, as you are correctly pointing out -- grossly misinformed.
It's really not. I've had a couple of replies that have helped me understand the view of those downvoting. I don't agree with it, but I have a better picture now.
I do not like to get downvoted but it is usually a failure on my part to set the right tone. I think your comment has a sleazy internet video ad vibe.
For sure medicine for hormonal levels can help a lot. Doctors miss diabetes and people die so of course you are right that testosteron is probably missed. The difference is accessibility everyone can check if they have high blood sugar by themselves, bad testosteron levels though the symptoms are not as clear there most certainly is not a 50% correlation between the symptoms and what you push.
So what would have worked for your comment is an anecdote maybe talk about it as the low possibility it is.
I don't mind being downvoted at all, and have never complained about it (and didn't here). I was just curious why.
I think you're right that people perceived a "sleazy" vibe. The sibling referred to "manosphere" and "advertising".
I wonder whether that reaction would have been different if the topic had been different. I.e. to what extent the reaction was due to the wording vs the subject matter. I think tesosterone treatment itself is seen as somehow sleazy, and I referred to that as a "stigma". I speculate that that perception has something to do with the fact that in 4 years I was never checked for an obvious potential cause to my symptoms. That experience is one reason I've chosen to be quite open about this treatment. I'd probably never have found it if it hadn't been for people I know talking about it.
I'm not sure it is a "low possibility", BTW. The prevalence and causes of hypogonadism aren't very well understood but it is common and may be rather more common since COVID. There are valid concerns about over-diagnosis, but under-diagnosis of this condition also carries risks.
Often, nothing at all is objectionable about a downvoted post. I've read many that are perfectly reasonable, intelligent and specific to an issue at hand, but they still get downvoted because they "went against" some particular hive mind tendency of the kinds of people who frequent this site and who were interested in that post.
It's an irrational response in many cases, and an ironic one in your case because what you wrote sounded decently reasonable, while i've seen other comments on other threads recommend all kinds of questionable nootropic and hallucinogenic drug therapies for X and Y reason, with no discernible downvoting. Those were "correct" I suppose.
Good idea: Don't write a comment with potential downvotes in mind. Use reasoned thinking, but also just say what you feel needs to be said and fuck the nitpicking you might get from pedantic idiots.
> Often, nothing at all is objectionable about a downvoted post. I've read many that are perfectly reasonable, intelligent and specific to an issue at hand, but they still get downvoted because they "went against" some particular hive mind tendency of the kinds of people who frequent this site and who were interested in that post
For me, I simply refuse to trade in the comment karma currency here. It’s so wishy-washy. I may post a comment or opinion that HN hates, but I am not going to self-censor an opinion on a topic I want to share just because I think might be HN controversial and receive downvotes. Also, I specifically want to read a heavily downvoted comment because often there are sometimes interesting takes in there. Also the dimming to me is annoying, it’s akin to shouting down a speaker rather than using reasonable debate and conversation to explore a topic.
Finally…I refuse to downvote any comment. Who am I to contribute to censoring a speaker for other people?
Agreed on all points, particularly about making a point to read downvoted comments because they might be unique takes. Because arbitrarily downvoted comments can become invisible or near invisible, on general principles i've never once downvoted one, even those whose opinions I absolutely hate, though I do sometimes upvote, like in the case of your reply, or, especially, comments that give me a good laugh or food for thought.
Can't speak for the downvoters, but your claims appear to be at odds with what Wikipedia has to say on the matter, and Wikipedia is usually a reliable source on medical consensus.
> Testosterone levels are well-documented to decline with aging at about 1% per year in both men and women after a certain age; the causes are not well understood.
That isn't describing normal aging. It's describing late-onset hypogonadism, which occurs in a subset of men. To see what happens to testosterone levels across the population, see the graphs in the first link from my original post. Through the 40s, 50s and 60s, variance increases but average levels don't significantly decline.
The condition I have could be late-onset hypogonadism (i.e. a slow drop over time) but based on the timing and nature of the onset of symptoms (and my age) is more likely to be a sharp drop in production following COVID. The difficulty in determining the latter for sure is that my levels before COVID were not known. This is also a challenge with determining the epidemiology of such sudden changes. Levels would need to be observed across the drop in a sufficient number of cases, but people are generally only measured after symptoms appear. Nonetheless, such drops are known to occur both due to injury and infection, and idiopathically.
You're suggesting my fatigue would have been better treated by lifestyle changes? Thing is, I tried that. I tried graded exercise as prescribed by a consultant. I saw a psychiatrist. I worked on diet and stress management. I tried supplements and probiotics. For 4 years I tried, in good faith, everything suggested. Then, at my own instigation, I was tested, diagnosed hypogonadic and prescribed testosterone, and now I am fully cured.
There's a certain frustration to being told your condition is a "lifestyle issue" by someone with absolutely no knowledge of your lifestyle. In my original post I linked an Imperial College paper about a potential mechanism for permanent testestorone reduction after COVID due to death of GnRH system neurons. What lifestyle change do you propose that would cause these to regrow?
Infertility shows up with both low and high levels of testosterone. So for some people taking testosterone actually increases sperm production while it harms others.
The issue with these kinds of discussions is people talk about “low T” without defining a specific number as low and normal.
Very true about the lack of a number, but that's part of the problem domain. A number that is healthy for one person is associated with symptoms of hypgonadism (that respond to treatment) in another. Complex dynamic systems are involved, and serum testosterone level is a single, crude measurement.
That's why I'd recommend anybody to get their levels of testosterone and other hormones checked periodically, so that any sudden change can be identified (and perhaps we can collect data to better understand the epidemiology of such sudden changes).
There's a persistent myth that testosterone production in men falls as a natural part of aging. The truth of what happens to "normal" levels with age is more complex [1] but what is known is that in some people testosterone production falls dramatically and permanently at some point at some point in their life, sometimes after an injury or infection, sometimes for no discernible reason, and it can cause exactly the symptoms described here. When that happens it's not a "male menopause". It's not normal aging. It's pathological and it's treatable. The reason to get your level checked even if you don't have symptoms is so you know your personal baseline and can tell if a sudden change happens later.
The situation in women is more complex, and testosterone treatment carries different risks, but androgens are very much part of healthy female hormone production.
It's early days but there's been some interesting research about a possible mechanism for permanent changes in androgen production after COVID [2].
I'm not saying this is the only cause of long COVID. There's certainly more than one mechanism, and what helps one person can harm another (as with the graded exercise program mentioned in the article, which was entirely counterproductive for me). But it is one of the possibilities and if it were routinely checked for in people reporting these symptoms it would have spared me a few years of hell.
1. https://europepmc.org/article/pmc/pmc4190174
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC10507138/