Low Testosterone

Normal aging in men is accompanied by a decline in testosterone production and function that may contribute to detrimental changes to overall male health.  Low testosterone affects roughly 39% of men over the age of 45 with the prevalence increasing with age.

What are the signs of low testosterone in men?

Low testosterone may affect the function of multiple organ systems and result in significant detriment in quality of life.  Common signs and symptoms include low energy, depressed mood, sleep disturbances, depressed cognition, impotence, and low libido.  But low testosterone may also unknowingly contribute to systemic disease including diabetes, high blood pressure, increased cardiovascular risk, and osteoporosis.

How is low testosterone diagnosed?

Low testosterone is diagnosed by a blood test. In order to treat a man for low testosterone, he should also have the signs and symptoms of low testosterone. Your physician will also likely check a PSA, a screening test for prostate disease.

What are the treatment options for low testosterone?

There are many treatment options for symptomatic low testosterone. Testosterone replacement therapy may be in the form of skin gel, injections, long acting pellets, patches or oral inserts. Intramuscular injections reliably increase T levels for hypogonadal men but testosterone levels may reach high levels and the current preparations available require repeat injections typically every 2-3 weeks.  Transdermal patches and gels are the most popular means of hormone replacement yet require daily administration with definite risk for transference to others.  One of the newer formulations available is T pellets implanted subcutaneously every 3-6 months.  It has benefits with fewer administrations and no risk of transference.

What are the benefits of testosterone replacement?

Testosterone replacement has been shown to improve a man’s energy, libido (sex drive), muscle mass, sleep, erections, energy level, and depressed mood. Testosterone replacement has been shown to also decrease body fat in men. There is data now to support that giving testosterone to a patient with low testosterone may increase their bone mineral density and decrease their risk for a bone fracture. It is important to realize that testosterone treatment is considered lifelong therapy, just like in other chronic conditions. Stopping testosterone replacement will result in a decline in a man’s testosterone level.

What are the side effects of testosterone replacement?

A prior history of prostate or breast cancer is considered an absolute contraindication for hormone replacement.  The belief of increase prostate size or PSA thus worsening lower urinary tract symptoms or risk of prostate cancer has not been demonstrated in several short-term studies.  Long term effects of T replacement are not well known at this time.  T replacement may also cause your body to make too many red blood cells.  Side effects from excessive supplementation of T and other rare problems include infertility, testicular atrophy, priapism, fluid retention, liver toxicity (uncommon with current preparations), hepatitis and hepatic tumors, sleep apnea and gynecomastia.

Click here for recent FDA statement regarding testosterone therapy

Source: Dr. Thom