What Men Need to Know about Low Testosterone

I am sure most of you have seen the ads on TV or heard them while listening to a podcast.  “Guys, are you feeling tired?  Having problems with stamina?  Need some extra help in the bedroom?  Then call (Company XYZ) for a supplement/prescription to boost your testosterone!”

So, what is testosterone?  Why do you need it?  Should you take a supplement?  And what should you expect if you do take a supplement or prescription?  Hopefully, this blog will answer these questions for you. (This blog will focus only on low testosterone in men as it is a “hot topic” that I feel needs addressed.)

WHAT IS TESTOSTERONE?

It is a hormone found in both men and women that has multiple functions.  In men, it is produced by the testicles and is responsible for development of sexual organs and characteristics of men.  In women, the ovaries produce much smaller amounts.  In both men in women, the adrenal gland (an organ that sits on top of each kidney) is also involved in production.  Besides having major roles in sexual function and development, it also plays a role in bone and muscle mass, fat storage in the body, and red blood cell levels.

WHAT CAUSES LOW TESTOSTERONE?

There are many things that may cause low testosterone in men and include:

·        Aging

·        Injury to the testicles

·        Chemotherapy and radiation treatments

·        Long standing health issues such as alcoholism, diabetes, liver and kidney failure, and HIV/AIDS

·        Long term use of opiate pain medications

·        Use of exogenous steroids (anabolic steroids as well as high dose prednisone)

WHAT HAPPENS IF IT IS LOW?

For men, low testosterone can result in the following:

·        Decreased sex drive

·        Erectile dysfunction

·        Fatigue

·        Depression

·        Thinner bones

·        Hair loss

·        Increases the risk of cardiovascular disease

·        Gynecomastia (enlarged breasts)

HOW DO I KNOW IF IT IS LOW?

Obtaining simple blood tests can tell if you have low testosterone. 

For men, a total testosterone level below 300 ng/dL on 2 separate tests each taken in the early morning (about 8AM) provides the most reliable diagnosis of low testosterone.  When patients have signs/symptoms of low testosterone (see above) combined with actual low blood testosterone levels, then you are diagnosed with testosterone deficiency. 

After being diagnosed, blood tests for other hormones (luteinizing hormone, or LH) should be taken to make sure the low testosterone is not coming from a problem with the pituitary gland in the brain.

WHAT CAN I DO TO INCREASE MY TESTOSTERONE?

There are a variety of treatments available from your doctor to treat testosterone deficiency.  These include:

·        Gels and patches applied to the skin

·        Oral agents (a pellet dissolved on the gums)

·        Nasal gels

·        Injections into the muscle (done either at home by the patient or in the office)

·        Insertion of pellets under the skin by a doctor

 Although there are several companies now selling testosterone “boosters” and supplements, there has not been consistent evidence that they effectively improve testosterone.  In addition, since they are not regulated by the FDA like prescription medications are, the purity and makeup of these agents is questionable.

WHAT ARE SOME OF THE SIDE EFFECTS OF TESTOSTERONE REPLACEMENT?

Side effects vary depending on the type of testosterone used (oral vs injection vs gel) but may include the following:

·        Redness or rash at the site of application (gels/patches)

·        Gum pain and irritation (oral dissolving agents)

·        Runny nose and bloody nose (nasal gels)

·        Injection site pain (for injectable forms)

In addition, patients on any form of testosterone need to have periodic blood tests taken to monitor their blood count, as a condition called polycythemia (high number of red blood cells) may occur. 

For patients over age 40, evaluation of the prostate is necessary as it is uncertain if testosterone treatment is safe for patients with active prostate cancer or a history of it. 

Finally, use of testosterone replacement may affect sperm counts and your ability to have children.

I DON’T WANT TO TAKE A PRESCRIPTION.  WHAT CAN I DO TO IMPROVE MY TESTOSTERONE NATURALLY?

Following basic healthy lifestyle choices may improve your testosterone without the use of prescription drugs.  This includes:

·        Regularly exercising

·        Lifting weights

·        Eating a diet consisting of adequate protein and healthy fats

·        Minimizing stress

·        Getting adequate sleep

·        Minimizing/avoiding the use of tobacco, alcohol, and marijuana

WILL I FEEL BETTER WITH TESTOSTERONE REPLACEMENT?

Patient receiving testosterone replacement may see improvement in the following:

·        Sex drive

·        Erectile function

·        Bone density

·        Lean body mass

·        Anemia (low blood count)

·        Depression

Research is inconclusive regarding testosterone replacement improving the following:

·        Thinking ability

·        Energy level

·        Fatigue

·        Cholesterol numbers

·        Overall quality of life

Furthermore, it is unclear whether testosterone replacement increases or decreases the risk of heart attack and stroke, even though low testosterone is a risk for cardiovascular disease.

I hope this clears up some of the misconceptions about low testosterone, how it may affect your health and ways to treat it.  If you think you may have low “T”, schedule an appointment so we can talk further and help you optimize your health!