Many 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 they also can be subtle. Testosterone levels decline naturally in men as they age over decades. But certain conditions can also lead to an abnormally low level. Symptoms of low testosterone include:
If a man has symptoms of low testosterone and tests show he has an abnormally 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. It is has also not been approved for treating men with low levels because of aging.
Testosterone replacement therapy is available in several forms. All can improve testosterone levels:
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.
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.
Testosterone replacement therapy side effects most often include rash, itching, or irritation at the site where the testosterone is applied.
However, there is also evidence of an increased risk of heart attack or stroke associated with testosterone use. Experts emphasize that the benefits and risks of long-term testosterone therapy are unknown, because large clinical trials haven’t yet been done.
There are a few health conditions that experts believe testosterone therapy can worsen:
It will be years before large clinical trials bring any answers on the long-term benefits and risks of testosterone therapy. As with any medicine, the decision on whether the possible benefits outweigh any risks is up to you and your doctor.
Isn’t taking testosterone replacement basically the same as taking steroids, like athletes that “dope”? It’s true that anabolic steroids used by some bodybuilders and athletes contain testosterone or chemicals that act like testosterone.
The difference is that doses used in testosterone replacement only achieve physiologic (natural) levels of hormone in the blood. The testosterone forms some athletes use illegally are in much higher doses, and often combined (“stacked”) with other substances that boost the overall muscle-building (anabolic) effect.
Drugs.com: “Androderm Side Effects.”
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Bhasin, S. Journal of Clinical Endocrinology and Metabolism, 2006.
Karen Herbst, MD, PhD, assistant professor in medicine, University of California, San Diego.
News release, FDA.