Acetyl-L Carnitine - An Alternative to Testosterone?
Many men, as they get older, lose their sex drive; this may be associated
with increased fatigue and sometimes depression. If their testosterone
level is low, they are often treated with this hormone, in one form or
another. But there are some risks (real or apparent) to the use of
testosterone, so an alternative effective treatment would be very welcome.
A group of Italian researchers have studied carnitine as a possible
substitute, and have reported their findings in the journal Urology.
Propionyl-l-carnitine and acetyl-l-carnitine are powerful antioxidants that
have proved beneficial in diseases typical of aging (e.g. Alzheimer's,
peripheral artery disease), according to some reports. Here's a summary of
What was done?
A total of 150 men aged 60 to 74 (average age: 66) were allocated randomly
to one of three groups. They had to have decreased libido and erectile
quality, depressed mood and ability to concentrate, irritability, fatigue,
and a free testosterone level below 6 pg/mL. They were not accepted if they
had prostatic enlargement, a raised PSA (prostate-specific antigen, a
marker for prostate cancer), smoked or drank alcohol, had diabetes, a
previous MI, or other possibly relevant diseases.
The first group was given testosterone undecanoate (160 mg/day), the second
group propionyl-l-carnitine plus acetyl-l-carnitine (2 g/day of each), and
the third group was given starch tablets (as a placebo). The treatment
period was 6 months.
A battery of lab tests and questionnaires were conducted before, during (at
3 and 6 months) and 6 months after the treatment. They covered
cardiovascular strength, sex drive, sexual satisfaction, hormone levels in
the blood, prostate size, PSA level, mood (using the Hamilton Depression
Scale), and fatigue.
Twelve men dropped out before treatment started, when they learned that
they might receive a placebo; 8 others dropped out during the study, but
this was not due to any side effect of treatment. This left 130 men in the
study - 40 on testosterone, 45 on carnitine, and 45 on placebo.
What was found
Both testosterone and carnitine improved sexual performance, as shown by
nocturnal penile tumescence measurements1 and the International Index of
Erectile Function score; carnitine was found to be more effective than
testosterone in this respect. Both treatments improved the blood flow
through the arteries supplying the penis to an equal extent; these
measurements had returned to baseline levels at 6 months after the end of
Testosterone has the reputation of increasing prostate size. This was
confirmed here - the testosterone treatment group had increased prostatic
volume at 3 and 6 months, which returned to normal after 6 months' off
treatment. At the same time, LH (luteinizing hormone) levels were lowered.
PSA levels were unchanged. Carnitine had no effect on prostate volume, LH,
or PSA levels.
Both testosterone and carnitine significantly improved the symptoms of
depression and fatigue, as measured by questionnaires. The side effects
reported were negligible, and were the same in each treatment group.
What does this mean?
In this study design, both testosterone and carnitine were effective in
improving the symptoms reported by some aging males. Carnitine was superior
to testosterone in their action on early symptoms of impotence, but
otherwise their effects were roughly equal. Testosterone was associate some
degree of prostate enlargement, but carnitine was not.
Does this mean aging men should consider carnitine rather than testosterone
for their problems? There are reasons for caution. First, the mechanism of
action of carnitine is not clear. The authors of the report state that the
reason other antioxidants (such as vitamin E, tocopherol, or glutathione)
don't work in aging men - while carnitine does - is because they have a
different point of attack in the biochemical processes. The rationale for
using testosterone, on the other hand, is clear.
Second, carnitines (acetyl-l- and propionyl-l-carnitine) have been
investigated for several years in several conditions: poor semen quality
leading to infertility, Peyronie's disease (bent shaft of penis),
peripheral arterial disease, and Alzheimer's disease. In none of these
conditions has carnitine proved to be an effective treatment in "adequate,
well-controlled clinical studies" - the FDA criterion for efficacy and
safety of a new drug. See the third link below, which takes a cool look at
the likely benefits of carnitine.
Clearly we need another well-controlled study, rather than basing a new
treatment on the results of this study alone. We can hope that this will be
done soon, and that the results confirm carnitine's superiority to the
potentially risky use of testosterone in older men. Otherwise, we must
conclude that this study is just another false alarm in the history of
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