Testosterone Replacement Therapy

Is this the key to male vitality?

Considering testosterone therapy to help you feel younger and more vigorous as you age? Know the pros and cons before you make your decision.

The possibilities of testosterone therapy are enticing — increase your muscle mass, sharpen your memory and concentration, boost your libido, and improve your energy level. As you get older, testosterone therapy may sound like the ultimate anti-aging formula. Yet the health benefits of testosterone therapy for age-related decline in testosterone aren't as clear as they may seem. Find out what's known — and not known — about testosterone therapy for normal aging.

What is testosterone?

Testosterone is a hormone produced primarily in the testicles. Testosterone helps maintain men's:

• Bone density
• Fat distribution
• Muscle strength and mass
• Red blood cell production
• Sex drive
• Sperm production

Hypogonadism is a disease in which the body is unable to produce normal amounts of testosterone due to a problem with the testicles or with the pituitary gland that controls the testicles. Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men. Doctors may prescribe testosterone as injections, pellets, patches or gels.

What happens to testosterone levels with age?

Testosterone peaks during adolescence and early adulthood. As you get older, your testosterone level gradually declines — typically about 1 percent a year after age 30. It is important to determine in older men if a low testosterone level is simply due to the decline of normal aging or if it is due to a disease (hypogonadism).

Does a naturally declining testosterone level cause the signs and symptoms of aging?

Not necessarily. Men can experience many signs and symptoms as they age, and some may occur as a result of lower testosterone levels and can include:

• Changes in sexual function.
  • This may include reduced sexual desire, fewer spontaneous erections — such as during sleep — and infertility.
• Changes in sleep patterns.
  • Sometimes low testosterone causes insomnia or other sleep disturbances.
• Physical changes.
  • Various physical changes are possible, including increased body fat, reduced muscle bulk and strength, and decreased bone density. Swollen or tender breasts (gynecomastia) and hair loss are possible. You may experience hot flashes and have less energy than you used to.
• Emotional changes.
  • Low testosterone may contribute to a decrease in motivation or self-confidence. You may feel sad or depressed, or have trouble concentrating or remembering things.

It's important to note that some of these signs and symptoms are a normal part of aging. Others can be caused by various underlying factors, including medication side effects, thyroid problems, depression and excessive alcohol use. A blood test is the only way to diagnose a low testosterone level.

Can testosterone therapy promote youth and vitality?

Testosterone therapy can help reverse the effects of hypogonadism, but it's unclear whether testosterone therapy would have any benefit for older men who are otherwise healthy.

Although some men believe that taking testosterone medications may help them feel younger and more vigorous as they age, few rigorous studies have examined testosterone therapy in men who have healthy testosterone levels — and some small studies have revealed mixed results. For example, in one study healthy men who took testosterone medications increased muscle mass but didn't gain strength.

What are the risks of testosterone therapy for normal aging?

Testosterone therapy has various risks. For example, testosterone therapy may:

• Contribute to sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts
• Cause your body to make too many red blood cells (polycythemia), which can increase the risk of heart disease
• Cause acne or other skin reactions
• Stimulate noncancerous growth of the prostate (benign prostatic hyperplasia) and possibly stimulate growth of existing prostate cancer
• Enlarge breasts
• Limit sperm production or cause testicle shrinkage

Should you talk to your doctor about testosterone therapy?

If you wonder whether testosterone therapy might be right for you, come in and talk with our doctor about the risks and benefits. A medical condition that leads to an unusual decline in testosterone may be a reason to take supplemental testosterone. However, treating normal aging with testosterone therapy is not currently advisable.