You may have seen ads making bold claims: feel younger, get stronger, improve your sex drive. The ads tend to be for therapies that contain a synthetic replacement for testosterone, which is a naturally occurring male hormone. Testosterone plays a vital role in the external development of genital organs and secondary sex characteristics — such as a deep voice, facial hair, and muscular build. Marketers tend to target middle-aged and older men since levels of the hormone fall with age. However, experts agree that testosterone is not a miracle drug that will cure all problems. Further, it comes with some important risks. The Food and Drug Administration has only approved testosterone therapy for low testosterone with a clear medical cause.
In addition to affecting voice and facial hair, testosterone impacts other parts of the body, including bone density, blood pressure and the creation of red blood cells. It’s produced primarily in the testicles, and testosterone levels vary greatly among men. Women make testosterone in their ovaries and adrenal glands, but they make much less. Testosterone blood levels generally peak during adolescence and early adulthood. As men age, testosterone levels gradually decline — typically about 1% a year after age 30 or 40. For older men, it’s important to determine if low testosterone is due to typical aging or if it is due to hypogonadism, which is a condition that hampers the ability to produce usual amounts of testosterone due to a problem with the testicles or with the pituitary gland that controls the output of the testicles. Although low testosterone levels decrease as men get older, marked reductions (hypogonadism) may develop due to obesity, diabetes, injury to the testicles, pituitary tumors or radiation treatment. The condition also may occur with use of drugs, such as opioids, cannabis or chemotherapy agents.
To be diagnosed with true hypogonadism, one needs to possess two factors:
- Low Testosterone Levels — This needs to be confirmed by at least two blood tests taken on separate days, as levels can fluctuate. There isn’t a standard “low” level, but most experts consider 240 nanograms per deciliter (ng/dL) the lower healthy limit.
- Symptoms — These may include decreased sexual desire, less energy, depression, loss of muscle mass, reduced body hair growth, development of breast tissue, or loss of bone density (osteoporosis).
Further testing can help determine the cause of low testosterone. Often its cause may be reversible without the need for testosterone replacement. But at other times, testosterone therapy may be considered. This therapy, in the form of injections, pellets, patches or gels, may improve symptoms of low testosterone.
Effects-not the same for all men: Men who don’t have hypogonadism will likely experience some of the symptoms of aging described above, although not as severely. Some of these symptoms can be caused by other factors, including medication side effects, obstructive sleep apnea, thyroid problems, diabetes and depression. It’s also possible that these conditions are causing low testosterone levels. Treating the conditions might increase testosterone levels without the need for testosterone replacement. Testosterone replacement therapy can help reverse the effects of hypogonadism, but it’s unclear whether it would help older men who are otherwise healthy. Although some men believe that they feel younger and more vigorous when they take testosterone therapy, there’s little evidence to support its use in otherwise healthy men. Although some evidence suggests that testosterone therapy might improve sexual function in some men, but there’s little evidence that it improves functions such as vitality and energy.
Risks may outweigh benefits: Testosterone therapy has various risks. Taking it can: 1) Worsen sleep apnea. 2) Cause acne or other skin reactions. 3) Stimulate noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer. 4) Enlarge breasts. 5) Limit sperm production or cause testicles to shrink. 6} Stimulate too much red blood cell production, which contributes to the increased risk of blood clots causing blocked blood flow in the lungs (pulmonary embolism). Testosterone replacement therapy also has been linked to an increased risk of heart disease, but recent research has found little to support that connection.
Before considering testosterone therapy, have a conversation with your caregiver. Often, treating other health conditions, changing medications or improving lifestyle factors — including losing excess weight and doing regular weight training exercises — can have a significant positive impact. Once one understands what’s causing symptoms, better solutions are available. Testosterone therapy is just one option. Knowing the benefits and risks can help one reach the best option. In any event, all evaluations must begin with careful analysis of one or more blood testosterone levels.
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