Low Testosterone Therapy: Risks and BenefitsTestosterone is a hormone that is produced primarily in the testicles for men and the testosterone replacement therapy benefits and risks and adrenal glands for women. This hormone is essential to tren e dosage development of male growth and masculine characteristics. For women, testosterone comes in much smaller amounts. Testosterone production increases about 30 times more during adolescence and early adulthood. Testosterone plays a key role in your:. You may be interested in boosting your testosterone levels if your doctor says you have low levels, or hypogonadismor testosteone testosterone replacement therapy for other conditions. If you have normal testosterone levels, increasing your testosterone levels may not give any additional benefits.
Testosterone therapy: Potential benefits and risks as you age - Mayo Clinic
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Get weekly health information and advice from the experts at Harvard Medical School. Learn more about this site in a welcome video from Dr. Marc Garnick, editor in chief. It could be said that testosterone is what makes men, men. It gives them their characteristic deep voices, large muscles, and facial and body hair, distinguishing them from women. It stimulates the growth of the genitals at puberty, plays a role in sperm production, fuels libido, and contributes to normal erections.
It also fosters the production of red blood cells, boosts mood, and aids cognition. As men get into their 50s, 60s, and beyond, they may start to have signs and symptoms of low testosterone such as lower sex drive and sense of vitality, erectile dysfunction, decreased energy, reduced muscle mass and bone density, and anemia.
Researchers estimate that the condition affects anywhere from two to six million men in the United States. Studies have shown that testosterone-replacement therapy may offer a wide range of benefits for men with hypogonadism, including improved libido, mood, cognition, muscle mass, bone density, and red blood cell production. But little consensus exists on what constitutes low testosterone, when testosterone supplementation makes sense, or what risks patients face.
Much of the current debate focuses on the long-held belief that testosterone may stimulate prostate cancer. He has developed particular expertise in treating low testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment strategies he uses with his own patients, and why he thinks experts should reconsider the possible link between testosterone-replacement therapy and prostate cancer. As a urologist, I tend to see men because they have sexual complaints.
The primary hallmark of low testosterone is low sexual desire or libido, but another can be erectile dysfunction, and any man who complains of erectile dysfunction should get his testosterone level checked. Men may experience other symptoms, such as more difficulty achieving an orgasm, less-intense orgasms, a smaller amount of fluid from ejaculation, and a feeling of numbness in the penis when they see or experience something that would normally be arousing.
The more of these symptoms there are, the more likely it is that a man has low testosterone. There are a number of drugs that may lessen sex drive, including the BPH drugs finasteride Proscar and dutasteride Avodart. Those drugs can also decrease the amount of the ejaculatory fluid, no question. But a reduction in orgasm intensity usually does not go along with treatment for BPH.
There are two ways that we determine whether somebody has low testosterone. One is a blood test and the other is by characteristic symptoms and signs, and the correlation between those two methods is far from perfect. Generally men with the lowest testosterone have the most symptoms and men with highest testosterone have the least. But there are some men who have low levels of testosterone in their blood and have no symptoms.
But no one quite agrees on a number. Is total testosterone the right thing to be measuring? Or should we be measuring something else? When most doctors learned about testosterone in medical school, they learned about total testosterone, or all the testosterone in the body.
Almost every lab has a blood test to measure free testosterone. For years, the recommendation has been to get a testosterone value early in the morning because levels start to drop after 10 or 11 a. But the data behind that recommendation were drawn from healthy young men. Two recent studies showed little change in blood testosterone levels in men 40 and older over the course of the day. One reported no change in average testosterone until after 2 p.
Between 2 and 6 p. There are some very interesting findings about diet. For example, it appears that individuals who have a diet low in protein have lower testosterone levels than men who consume more protein. In this article, testosterone-replacement therapy refers to the treatment of hypogonadism with exogenous testosterone — testosterone that is manufactured outside the body.
Depending on the formulation, treatment can cause skin irritation, breast enlargement and tenderness, sleep apnea, acne, reduced sperm count, increased red blood cell count, and other side effects. Preliminary research has shown that clomiphene citrate Clomid , a drug generally prescribed to stimulate ovulation in women struggling with infertility, can foster the production of natural testosterone, termed endogenous testosterone, in men.
In a recent prospective study, 36 hypogonadal men took a daily dose of clomiphene citrate for at least three months. Within four to six weeks, all of the men had heightened levels of testosterone; none reported any side effects during the year they were followed. Because clomiphene citrate is not approved by the FDA for use in men, little information exists about the long-term effects of taking it including the risk of developing prostate cancer or whether it is more effective at boosting testosterone than exogenous formulations.
But unlike exogenous testosterone, clomiphene citrate preserves — and possibly enhances — sperm production. That makes drugs like clomiphene citrate one of only a few choices for men with low testosterone who want to father children. Formulations What forms of testosterone-replacement therapy are available? The disadvantage is that a man needs to come in every few weeks to get a shot. A roller-coaster effect can also occur as blood testosterone levels peak and then return to baseline. Topical therapies help maintain a more uniform level of blood testosterone.
The first form of topical therapy was a patch, but it has a very high rate of skin irritation. That limits its use. The most commonly used testosterone preparation in the United States — and the one I start almost everyone off with — is a topical gel. There are two brands: The gel comes in miniature tubes or in a special dispenser, and you rub it on your shoulders or upper arms once a day.
The concentration of testosterone in the blood actually goes up quite quickly, within a few doses. I usually measure it after two weeks, though symptoms may not change for a month or two. There are pills in the United States for testosterone supplementation, but their use is strongly discouraged because they cause significant liver toxicity. A safe oral formulation called testosterone undecanoate is available in Canada and in Europe, but not in the United States. It lasts for 12 weeks, so a patient could come in and get a shot about four times a year.
In December , the brand name of the drug in the United States was changed to Aveed. As of January , it was still awaiting FDA approval. Future Research and Current Practice Recommendations. Journal of Clinical Endocrinology and Metabolism ; Journal of Clinical Endocrinology and Metabolism ; Other than improvement in sexual symptoms, what are some of the potential benefits of testosterone-replacement therapy?
Some studies have looked at testosterone therapy and cognition. Other studies have shown that it improves mood.
Testosterone therapy has also been shown to be effective in the treatment of osteoporosis and in increasing muscle bulk and strength. When patients ask about risks, I remind them that they already have testosterone in their system and that the goal of testosterone treatment is to restore its concentration back to what it was 10 or 15 years previously.
And the molecule itself that we give is identical to the one that their bodies make naturally, so in theory, everything should be hunky-dory. But in practice, there are always some curveballs. For example, testosterone can increase the hematocrit, the percentage of red blood cells in the bloodstream.
If the hematocrit goes up too high, we worry about the blood becoming too viscous or thick, possibly predisposing someone to stroke or clotting events. Nevertheless, the risk exists, so we want to be careful about giving testosterone to men who already have a high hematocrit, such as those with chronic obstructive pulmonary disease, or those who have a red-blood-cell disorder. It became a standard therapy that we still use today for men with advanced prostate cancer.
We call it androgen deprivation or androgen-suppressive therapy. The thinking became that if lowering testosterone makes prostate cancer disappear, at least for a while, then raising it must make prostate cancer grow. If you look at men who show up for prostate cancer screening, same sort of age population, the rate tends to be about the same.
They can then look at blood samples taken at the start of the study to see if, for example, the group that got prostate cancer had a higher level of testosterone over all. About , men have been entered in some 20 trials of this type around the world. Not one of those studies has shown a definitive correlation between prostate cancer and total testosterone. Three or four have shown weak associations, but none of those have been confirmed in subsequent studies.
We almost never see it in men in their peak testosterone years, in their 20s for instance. The evidence shows that testosterone treatment does not change the strength or rate of urine flow, does not change the ability to empty the bladder, and does not change other symptoms such as frequency or urgency of urination, as assessed by the American Urological Association Symptom Score or the International Prostate Symptom Score. Studies have come to conflicting conclusions about whether high levels of testosterone increase the risk of developing prostate cancer.
A sampling of studies that have helped drive the controversy follows. Serum Testosterone and the Risk of Prostate Cancer: Potential Implications for Testosterone Therapy. Cancer Epidemiology, Biomarkers, and Prevention ; Hormonal Predictors of Prostate Cancer: Journal of Clinical Oncology ; Endogenous Sex Hormones and Prostate Cancer: A Quantitative Review of Prospective Studies.
British Journal of Cancer ; Testosterone and Prostate Cancer: An Historical Perspective on a Modern Myth. Slater S, Oliver RT.