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'Low T' Therapy: Is It for Me?

Despite widespread ad campaigns, testosterone replacement isn't a panacea, but can help some men, experts say
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Dr. Steven Canfield, chief of urology at the University of Texas Health Science Center at Houston, said that symptoms of low testosterone that men might notice also include "the development of breast tissue, a loss of body hair, small or shrinking testicles, no need for shaving, flushing, sweats and bone loss."

But, he said, there are less specific symptoms, too. Men with low testosterone might also notice "a decrease in self-confidence, feeling sad or depressed, problems with sleeping, memory problems, reduction in body mass, and a decrease in work performance," Canfield said.

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."

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