'Low T' Therapy: Is It for Me?
Despite widespread ad campaigns, testosterone replacement isn't a panacea, but can help some men, experts say
All it takes to tell if a man's testosterone level is low, he said, is a simple blood test.
Although low testosterone is common in older men, it's not necessarily a normal part of aging. Other conditions that are common with aging, such as obesity or depression, can cause lower levels of testosterone, according to research presented at the Endocrine Society meeting in Houston this year.
Canfield said that testosterone levels can drop if testicular tissue is lost, which can happen with age. And Terlecki said that prior testicular trauma, undescended testicles and radiation treatment to the testicles also can cause lower testosterone levels. Testosterone levels can drop because of a pituitary tumor, though that's rare, he said. And some medications, such as narcotics, can also lower testosterone levels.
Several options exist for treating low testosterone. For men who want to keep their fertility, Terlecki said, the drug clomiphene can be prescribed. In men for whom that's no longer an issue, testosterone replacement therapy can boost testosterone levels.
Options for testosterone replacement, Canfield said, include injections, patches, a gel and implantable pellets. He said that a pill form of testosterone is available in other parts of the world, but not in the United States.
Injections are given once every two weeks, Terlecki said. The downside to this option is that injections provide a large dose of testosterone in the beginning but it drops fairly quickly.
Topical formulations, such as testosterone gel, are put on in the morning and absorbed within two to six hours and, if used consistently, provide a steady consistent dose of testosterone. "But, men have to remember to do it," Terlecki said. "And, they have to wait while the gel dries. It may leave the area feeling a little tacky."
Also, it's important not to expose children, pregnant women or women who may become pregnant to the testosterone on the skin because it can alter their hormonal balance.
Patches can provide a longer-term steady dose of testosterone, but they may cause irritation, Terlecki said. And implantable pellets, according to Canfield, can provide a steady, long-acting dose of testosterone. They're injected just underneath the skin on your backside during an outpatient office procedure.
This option is becoming increasingly popular because it lasts for four months and generally is inexpensive, Terlecki said.
Risks of testosterone therapy include an increase in the size of the prostate, water retention, worsening sleep apnea, a lower sperm count and an increase in the platelet count, which could increase the risk for blood clots, according to Canfield.
Both men agreed that testosterone therapy won't solve all of a man's health issues.
"The most important thing men need to know is that testosterone therapy isn't a substitute for taking care of overall health," Terlecki said. "A lot of men come in obese, with a poor diet and no exercise, and they want to blame low testosterone. While testosterone may play a role in their overall health, it needs to be viewed in context with these other factors."