Dear Healthy Men: A recent news release suggested that men with low testosterone levels may have improvement in sexual function and quality of life. How can I determine whether I can benefit and what questions should I ask my doctor?
A: Before we get into the details of the newly reported benefits of testosterone therapy—including the scope of those benefits and the men most likely to see them—let’s talk about what, exactly, testosterone is, what it does, and what constitutes “low levels” (also sometimes referred to as “low T,” “andropause,” or even “male menopause”).
To start with, testosterone is the most important male hormone (although women have measurable levels as well). In a nutshell, it’s what makes men men—at least physically. It’s manufactured in the testicles and plays a significant role in puberty (including penis and testicle growth and voice deepening), muscle and bone growth and development, strength, sex drive, and fertility.
Testosterone levels are usually measured with a blood test and are reported in terms of nanograms per deciliter (abbreviated as ng/dL). The normal range for men 20-70 is 300-1000 ng/dL. However, starting at about age 30, men’s levels gradually decrease by an average of 1-2% per year. According to the journal Annals of Internal Medicine, the symptoms of low testosterone include “little or no interest in sex, erectile dysfunction, less energy/feeling weak, mood changes and feeling depressed, loss of bone mineral density, and loss of body and facial hair.” However, there is significant debate as to “whether these symptoms are truly associated with low testosterone or if they are a result of other factors, such as chronic illness or certain medications.”
Studies have found that 20%-40% of males ages 30-70 have low testosterone levels (although it’s important to note that not all of them will have any negative symptoms).
Okay, now let’s talk about the news stories you may have heard about. The study in question evaluated 38 other high-quality studies and focused on men with age-related low testosterone and the effects of testosterone replacement therapy (TRT). The findings were fairly limited: Overall, men who received TRT experienced “small improvements in sexual function and quality of life.” The researchers did not find that TRT offered any benefits for other age-related issues, such as lack of energy, mood, strength, memory, or cognitive ability. And they were unable to shed any new light on any of the previously reported links between testosterone replacement therapy and heart health, prostate cancer, or mortality.
So, what should you do if you think you might have age-related low testosterone? The Washington DC-based non-profit, Men’s Health Network (menshealthnetwork.org), recommends that you discuss your symptoms with your doctor and ask for a blood test. If your levels come back low, you should ask your doctor the following questions recommended by the American College of Physicians (ACP): Will taking TRT help with the symptoms that I came to discuss with you? What method of TRT is best for me? What are the risks and side effects of treatment? And How long will it take for TRT to work, and what if it does not work?
Men’s Health Network supports the ACP’s guidelines, which recommend that doctors consider offering TRT via intramuscular injection rather than a patch, gel, or pellet. The ACP believes that injections are cheaper yet just as effective as other methods and involve similar side effects. However, they recognize that injections (which will need to happen every 1-4 weeks) may not be for everyone.