Low testosterone (Low T) and
testosterone therapy—you hear about it on TV, on the Internet, and at the gym.
Should every man consider testosterone therapy once he reaches a certain age? Should
it be considered when and if symptoms appear or before symptoms appear? Is it
safe? Here is information that can help you decide.
Are the Symptoms of Low T?
It is normal for a man’s
testosterone level to decrease gradually with age. It is also normal to have
fewer erections as a man ages, but it is not normal to be unable to have or
sustain an erection, and it is not normal to lose interest in sex. The
following are the most common symptoms that have been associated with low blood
levels of testosterone.
- a decreased sex drive (libido) and problems
including erectile dysfunction (ED) and a decrease in the number and quality of
- smaller testes (hypogonadism) and a lower sperm
- fatigue and mood changes including depression,
irritability, anxiety, problems with memory and concentration, or a sudden lack
- swollen or tender breasts (gynecomastia)
- decreased muscle mass, decreased strength and
endurance, changes in blood lipids such as cholesterol levels, osteopenia
(softening of the bones), and osteoporosis (decreased bone density)
- hot flashes
Is Low Testosterone Diagnosed?
Your doctor will ask you a number
of questions, many having to do with your sexual activity. You should also undergo
a full physical exam to rule out any other number of disorders that may be
causing your problem. In addition, your blood will be tested for testosterone
levels. The test is most often done using blood drawn in the morning—this is
usually when testosterone levels are highest. If the combination of symptoms
and lab results indicate low testosterone levels, you may want to consider
testosterone therapy. Currently, it is not recommended that anyone use
testosterone therapy before the lab tests and symptoms indicate a need.
Recent reviews from the
University of Ohio and Tulane University have
shown that there are a number of benefits of testosterone therapy (TT). In
addition to helping with ED, energy levels, and sexual desire, there are
benefits for treating osteoporosis and depression, and potentially heart
disease. There are testosterone pills, but these are used infrequently because
they are poorly absorbed and have been associated with liver damage. TT is
- Gels or a patch applied to the skin of the back,
abdomen, inner thigh, upper arm, or scrotum every day. The testosterone is
slowly and evenly absorbed through the skin throughout the day. The gels and
patches can cause skin irritation and itching. Women and children should not
touch the areas where the testosterone was applied.
- Injections can be given every seven to 22 days. The
testosterone levels rise in the first three to four days after injection, but
can vary widely in the days between injections. The injections can be quite
painful, as well. This is the least expensive TT option, however.
- Tablets with testosterone can be placed in the
cheek or between the upper lip and gums every 12 hours and allowed to dissolve.
These tablets have the advantage that a compounding pharmacy can provide you
with very specific doses (and flavors) so that your testosterone levels can be
adjusted to give you the best results. Some gum irritation can result, but usually
goes away within about two weeks.
Should Not Use Testosterone Therapy?
Testosterone use is not
recommended for men with sleep apnea, a high red blood cell count, congestive
heart failure, or prostate conditions such as benign prostatic hypertrophy
(BPH) or prostate cancer. Testosterone can cause swelling of the breasts or
ankles, acne, and an increased risk of strokes and possibly BPH.
Testosterone Boosters or Supplements
There are a number of natural
herbs and supplements that have been used to boost the natural production of
testosterone. These herbs include Tribulus terrestris, Withania somnifera (ashwagandha),
Ginkgo biloba, Lepidium meyenii (maca),
and Yohimbe. These have been used for centuries, but few studies
exist to provide scientific evidence for their use or safety.
Other substances that have been
used are DHEA (dihydroepiandrosterone), the amino acid arginine and pycnogenol,
a plant sterol. DHEA is a natural building block that the body can use to
synthesize testosterone, but is generally not recommended because of possible significant
side effects and a lack of evidence showing any positive effects. Arginine and pycnogenol, on the other hand,
have shown promise as safe agents to treat ED.