Important Testosterone Information

Although it’s normal for testosterone levels to drop as men age, low testosterone can affect a man’s health. In many ways, testosterone is the stuff that makes men men. The rush of new testosterone in puberty builds muscle and bone, deepens the voice, and revs up the sex drive. Throughout a man’s life, testosterone maintains his male characteristics.

Testosterone levels start to decline at age 30 and decline steadily after age 40. The decline averages about 1% to 2% per year. By middle age and older, virtually all men experience some decline in testosterone. A certain percentage of aging men have testosterone levels far below those considered normal for their age.

Is this low testosterone part of normal aging? Is low testosterone a medical problem that needs treatment? The answer is yes and yes.

Most men with symptoms of low testosterone will get some benefit from treatment (testosterone replacement therapy or TRT).

What is Low Testosterone?
In our practice, low testosterone is defined as a free testosterone of less than 2 ng/dl and/or a total testosterone of less than 400 ng/dl, but the blood test itself does not indicate the need for TRT. The patient must have symptoms. The symptoms of low testosterone include low sex drive, erectile dysfunction, mood problems such as anxiety and depression, weakness, fatigue, decrease in muscle mass and sleep disturbances. Of all men with below-normal testosterone levels, approximately three-fourths report symptoms.

Unlike a woman’s menopause, when estrogen levels plummet over months to very low levels, men’s andropause is a gradual decline of testosterone levels over years. The effects of low testosterone can be insidious and even go unnoticed.

Some men with low testosterone levels have symptoms without recognizing them. They may still have a sex drive, but not realize how much it’s declined.

Men with symptoms of low testosterone can have significant impairment in quality of life. Current medical thinking is that these men should be treated with TRT.

Low testosterone can be treated by once or twice weekly injections or a transdermal cream. Our recommendation is to raise the total testosterone level to the optimal range of 800 ng/dl.
Patients may also be prescribed an estrogen blocker such as anastrozole and human chorionic gonadotropin to help prevent testicular atrophy which may occur with continued TRT.

Health Effects of Low Testosterone
Low testosterone is associated with several chronic medical conditions, including obesity, diabetes, depression, and possibly cardiovascular disease. In our opinion, it’s not clear at all that low testosterone causes these conditions. In fact, it might be the other way around.

The same processes that lead to medical illness such as diabetes and high blood pressure could potentially also be the causes of low testosterone. It’s possible that low testosterone levels serve as a marker of health decline in general.

Testosterone builds bone, and low testosterone can lead to thinning of the bones, called osteoporosis. Men with hip fractures tend to have low testosterone. As yet, there is no proof that TRT reduces fracture risk. Still, most physicians would treat a man with low bone density with testosterone.

Testosterone Replacement: Benefits and Risks
Prescriptions for testosterone replacement have risen more than 17 fold in recent years. Our physician experts applaud the increase, as TRT in the prescribed doses is felt to be safe and efficacious.

Some evidence suggests that many men with symptomatic low testosterone don’t get treated. In a recent study, Boston area men were found to have low treatment rates.

Only about 12 percent of men from Boston with symptomatic androgen deficiency were being treated. Without access to the medical data, we can’t say they should have been. But we can say that it didn’t seem to be due to poor access to care or unwillingness on their part.
Men have a varied response to testosterone replacement.

At Griffin Medical Group, about 5% of men don’t get much of a response. About 95% see improvement, and about 40% of those are extremely satisfied. In clinical studies, the majority of men with low testosterone have improved erectile dysfunction and sex drive with TRT.
According to the Endocrine Society’s clinical guidelines, certain men shouldn’t take testosterone supplements. Men with metastatic prostate cancer or breast cancer shouldn’t. Other conditions can potentially be made worse by TRT such as severe benign prostatic hypertrophy, severe congestive heart failure, or high red blood cell counts.

Clinical trials to evaluate the benefits of testosterone replacement are underway. Until then, men with low testosterone symptoms whose blood tests show low testosterone levels should consider TRT.That’s if those men can get themselves to speak up about symptoms of low testosterone, though. Many of our male patients don’t ask about TRT and they should.

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