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.
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)
Fatigue and poor energy level
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.
AXIRON is a prescription medication used to treat adult men who have low or no testosterone. AXIRON is not intended for use in women or anyone under 18 years of age. It is not known if AXIRON is safe and effective in children younger than 18 years old. Improper use of AXIRON may affect bone growth in children.
IMPORTANT SAFETY INFORMATION FOR AXIRON
What is the most important information I should know about AXIRON?
AXIRON can transfer from your body to others. This can happen if other people come into contact with the area where the AXIRON was applied. Signs of puberty that are not expected (for example, pubic hair) have happened in young children who were accidentally exposed to testosterone through skin to skin contact with men using topical testosterone products like AXIRON. Women and children should avoid contact with the unwashed or unclothed area where AXIRON has been applied. If a woman or child makes contact with the application area, the contact area on the woman or child should be washed well with soap and water right away.
To lower the risk of transfer of AXIRON from your body to others, follow these important instructions:
Apply AXIRON only to your armpits.
Wash your hands right away with soap and water after applying AXIRON.
After the solution has dried, cover the application area with clothing. Keep area covered until you have washed the application area well or have showered.
If you expect another person to have direct skin-to-skin contact with your armpits, first wash the application area well with soap and water.
Stop using AXIRON and call your healthcare provider right away if you see any signs and symptoms in a child or a woman that may have occurred through accidental exposure to AXIRON. Signs and symptoms in children may include enlarged penis or clitoris; early development of pubic hair; increased erections or sex drive; aggressive behavior. Signs and symptoms in women may include changes in body hair and a large increase in acne.
Who should not use AXIRON?
Do not use AXIRON if you:
have or might have prostate cancer
have breast cancer
are pregnant or may become pregnant or are breast-feeding. AXIRON may harm your unborn or breast-feeding baby.
Women who are pregnant or who may become pregnant should avoid contact with the area of skin where AXIRON has been applied.
What should I tell my healthcare provider before using AXIRON?
Before you use AXIRON, tell your healthcare provider if you have:
or might have prostate cancer
urinary problems due to an enlarged prostate
kidney or liver problems
problems breathing while you sleep (sleep apnea)
any other medical conditions
Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Using AXIRON with other medicines can affect each other. Especially, tell your healthcare provider if you take:
medicines that decrease blood clotting
What are the possible side effects of AXIRON?
AXIRON can cause serious side effects. Call your healthcare provider right away if you have any of the following:
If you already have enlargement of your prostate gland, your signs and symptoms can get worse while using AXIRON. This can include: increased urination at night, trouble starting your urine stream, having to pass urine many times during the day, having an urge that you have to go to the bathroom right away, having a urine accident, being unable to pass urine or weak urine flow.
Possible increased risk of prostate cancer. Your healthcare provider should check for prostate cancer or any other prostate problems before you start and while you use AXIRON.
In large doses AXIRON may lower your sperm count.
Swelling of your ankles, feet, or body.
Enlarged or painful breasts.
Problems breathing while you sleep (sleep apnea).
Blood clots in the legs. This can include pain, swelling or redness of your legs.
The most common adverse events include: skin redness or irritation where AXIRON is applied, increased red blood cell count, headache, diarrhea, vomiting, and increase in blood level of Prostate Specific Antigen (a test used to screen for prostate cancer). Other side effects include more erections than are normal for you or erections that last a long time.
AXIRON is flammable until dry. Let AXIRON dry before smoking or going near an open flame.
Axiron is available by prescription only
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
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