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Is Testosterone Replacement Therapy Right for You?

Many aging men with low testosterone report improved energy levels, sex drive, and mood after testosterone treatment. If testosterone is low, why not replace it?

Not so fast. A low testosterone level by itself doesn't need treatment. Testosterone replacement therapy can have side effects, and the long-term risks and benefits aren't known. Only men with symptoms of low testosterone and blood levels that confirm this as the cause of symptoms should consider testosterone replacement. Talking with your doctor is the only way to know if testosterone therapy is right for you.

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Subtle Symptoms of Low Testosterone

The symptoms of low testosterone are sometimes obvious, but can be subtle. Testosterone levels decline naturally in men as they age over decades, and symptoms may appear slowly. Low testosterone symptoms include:

  • Low sex drive (libido)
  • Erectile dysfunction
  • Fatigue and poor energy level
  • Difficulty concentrating
  • Depression
  • Irritability
  • Low sense of well-being

If a man has symptoms of low testosterone and tests show he has a low testosterone level, a doctor may suggest treatment. For millions of men who have low testosterone levels but no symptoms, no treatment is currently recommended.

Forms of Testosterone Supplements

Testosterone replacement therapy is available in several forms. All can improve testosterone levels:

  • Skin patch (transdermal): Androderm is a skin patch worn on the arm or upper body. It's applied once a day.
  • Gels: AndroGel and Testim come in packets of clear testosterone gel. Testosterone is absorbed directly through the skin when you apply the gel once a day. AndroGel, Axiron, and Fortesta also come in a pump that delivers the amount of testosterone prescribed by your doctor. Natesto is a gel applied inside the nose.
  • Mouth patch: Striant is a tablet that sticks to the upper gums above the incisor, the tooth just to the right or left of the two front teeth. Applied twice a day, it continuously releases testosterone into the blood through the oral tissues.
  • Injections and implants: Testosterone can also be injected directly into the muscles, or implanted as pellets in the soft tissues. Your body slowly absorbs the testosterone into the bloodstream.

Why not a simple testosterone pill? Oral testosterone is available. However, some experts believe oral testosterone can have negative effects on the liver. Using other methods, such as skin patches, gels, orally disintegrating tablets, or injections, bypasses the liver and gets testosterone into the blood directly.

Benefits of Testosterone Therapy

What can you expect from testosterone treatment? It's impossible to predict, because every man is different. Many men report improvement in energy level, sex drive, and quality of erections. Testosterone also increases bone density, muscle mass, and insulin sensitivity in some men.

Men also often report an improvement in mood from testosterone replacement. Whether these effects are barely noticeable, or a major boost, is highly individualized.

Karen Herbst, MD, PhD, an endocrinologist at University of California-San Diego, specializes in testosterone deficiency. She estimates about one in 10 men are "ecstatic" about their response to testosterone therapy, while about the same number "don't notice much." The majority have generally positive, but varying responses to testosterone replacement.

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