It is well known now that as a man ages, his testosterone level declines over time. This is known as “andropause,” a word that is similar to the well-known “menopause” that describes the loss of hormones in a woman as she ages. When testosterone levels drop, men experience symptoms that can be upsetting. The FDA (the Food and Drug Administration) states that 4 to 5 million men in the United States suffer with low testosterone, but only 5 percent are being actively treated.
What are the symptoms of low testosterone?
• Loss of muscle mass and strength
– A decline in muscle mass in the aging male is directly correlated with increased risk for falls and fractures
• Loss of bone density and the onset of osteoporosis
• Increase in body fat, especially in the abdomen and breast area
• Decline in physical stamina and performance
– The need for more effort to achieve results is noticed
• Low sex drive and less frequent sexual thoughts
• More frequent problems achieving and maintaining erections
– Loss of early morning erections
• Less penile sensitivity and quality of orgasms
• More fatigue and sense of lower energy level and vigor
• Decline in motivation to get things done
• Less overall feeling of well-being
• Increased irritability
• More frequent bouts of depression
• Less ability to concentrate
• Loss of cognitive skills and memory
• More problems with sleep
• Increased risk of high cholesterol and coronary artery disease
Often these symptoms are attributed to stress or just “getting older, so what do you expect?”
What are the benefits of replacing testosterone?
Thousands of men throughout the United States are replacing the testosterone that has declined in their bodies as they age. Testosterone has been shown to help treat and resolve all the problems listed above especially in the following areas:
• Muscle tone
• Bone strength
• Mood and motivation
• Brain function
• Heart function
What are the side effects or risks of replacing testosterone?
• Water retention (rare)
• Polycythemia (too many red blood cells)
• Liver toxicity (only with pills, not injections)
• Sleep apnea (it could make a preexisting condition worse, but when CPAP is being used, it helps with weight loss and ultimately helps sleep apnea improve and even go away)
• Prostate enlargement (if the testosterone becomes DHT as described below)
• Growth of preexisting prostate cancer (although this is has been disputed by the best urologists in the country)
• Adverse lipid profile (only if too much is given)
• Breast growth (if too much testosterone is given and if the testosterone is changed into too much Estrogen)
• Acne (reversible and uncommon)
• Hair loss (if the testosterone becomes DHT as described below)
• Infertility (usually not a concern for the aging man, and can be addressed and treated if this is a concern)
How is Testosterone given?
There are many ways to administer testosterone. The two most common ways are by 1) gel, cream or patch to use on the skin or 2) by injection.
When testosterone is put on the skin it often goes into the body and can be turned into the unwanted substance known as DHT (Dihydro-testosterone). DHT can enlarge the prostate and lead to prostate cancer. In other words, men who use testosterone patches or rub it onto their skin have a higher chance of the testosterone becoming DHT. Injection is the safest way to give testosterone because less of it becomes DHT.
Most men learn how to give the injections to themselves. It is best when given twice a week. When the gluteal (buttocks) muscles are used, injections should be given into the upper, outer part of the buttock to avoid damaging the sciatic nerve. Injections can also be given in the upper thigh muscle, but this may cause aching in the leg and that is why more men prefer the buttocks. Injection fibrosis (thickening of tissue in that area) is a complication that may occur if the injections are delivered with great frequency in the same place or with improper technique.
While receiving the testosterone injections, blood should be regularly monitored with lab tests to check on blood levels of testosterone and to check blood count. The PSA level (the prostate test) should also be checked more frequently than the usual once a year.