Low testosterone (Low T) and testosterone therapy—you hear about it on TV, on the Internet, and at the gym. Should every man consider testosterone therapy once he reaches a certain age? Should it be considered when and if symptoms appear or before symptoms appear? Is it safe? Here is information that can help you decide.
What Are the Symptoms of Low T?
It is normal for a man’s testosterone level to decrease gradually with age. It is also normal to have fewer erections as a man ages, but it is not normal to be unable to have or sustain an erection, and it is not normal to lose interest in sex. The following are the most common symptoms that have been associated with low blood levels of testosterone.
- a decreased sex drive (libido) and problems including erectile dysfunction (ED) and a decrease in the number and quality of erections
- smaller testes (hypogonadism) and a lower sperm count
- fatigue and mood changes including depression, irritability, anxiety, problems with memory and concentration, or a sudden lack of self-confidence
- swollen or tender breasts (gynecomastia)
- decreased muscle mass, decreased strength and endurance, changes in blood lipids such as cholesterol levels, osteopenia (softening of the bones), and osteoporosis (decreased bone density)
- hot flashes
How Is Low Testosterone Diagnosed?
Your doctor will ask you a number of questions, many having to do with your sexual activity. You should also undergo a full physical exam to rule out any other number of disorders that may be causing your problem. In addition, your blood will be tested for testosterone levels. The test is most often done using blood drawn in the morning—this is usually when testosterone levels are highest. If the combination of symptoms and lab results indicate low testosterone levels, you may want to consider testosterone therapy. Currently, it is not recommended that anyone use testosterone therapy before the lab tests and symptoms indicate a need.
Type of Therapy
Recent reviews from the University of Ohio and Tulane University have shown that there are a number of benefits of testosterone therapy (TT). In addition to helping with ED, energy levels, and sexual desire, there are benefits for treating osteoporosis and depression, and potentially heart disease. There are testosterone pills, but these are used infrequently because they are poorly absorbed and have been associated with liver damage. TT is available as:
- Gels or a patch applied to the skin of the back, abdomen, inner thigh, upper arm, or scrotum every day. The testosterone is slowly and evenly absorbed through the skin throughout the day. The gels and patches can cause skin irritation and itching. Women and children should not touch the areas where the testosterone was applied.
- Injections can be given every seven to 22 days. The testosterone levels rise in the first three to four days after injection, but can vary widely in the days between injections. The injections can be quite painful, as well. This is the least expensive TT option, however.
- Tablets with testosterone can be placed in the cheek or between the upper lip and gums every 12 hours and allowed to dissolve. These tablets have the advantage that a compounding pharmacy can provide you with very specific doses (and flavors) so that your testosterone levels can be adjusted to give you the best results. Some gum irritation can result, but usually goes away within about two weeks.
Who Should Not Use Testosterone Therapy?
Testosterone use is not recommended for men with sleep apnea, a high red blood cell count, congestive heart failure, or prostate conditions such as benign prostatic hypertrophy (BPH) or prostate cancer. Testosterone can cause swelling of the breasts or ankles, acne, and an increased risk of strokes and possibly BPH.
Natural Testosterone Boosters or Supplements
There are a number of natural herbs and supplements that have been used to boost the natural production of testosterone. These herbs include Tribulus terrestris, Withania somnifera (ashwagandha), Ginkgo biloba, Lepidium meyenii (maca), and Yohimbe. These have been used for centuries, but few studies exist to provide scientific evidence for their use or safety.
Other substances that have been used are DHEA (dihydroepiandrosterone), the amino acid arginine and pycnogenol, a plant sterol. DHEA is a natural building block that the body can use to synthesize testosterone, but is generally not recommended because of possible significant side effects and a lack of evidence showing any positive effects. Arginine and pycnogenol, on the other hand, have shown promise as safe agents to treat ED.