If you read, listen to the radio, or surf the Internet, you can’t miss seeing or hearing, “Low T?” “T” refers to testosterone, commonly referred to as the male hormone. Actually, women need testosterone too, as it is an important precursor for estrogen, the female hormone. Testosterone is chiefly made in the gonads of men (testes) and women (ovaries) in response to complex signals from the pituitary gland and hypothalamus of the brain. Testosterone (and estrogen) levels can decrease for many reasons, and this certainly happens as we age. Levels of testosterone start decreasing in the early 20s. Fortunately, there is a broad range of normal. However, by the age of 50-60, the testosterone level may fall below the normal range. Testosterone has been implicated in depression, decreasing lean muscle mass, muscle strength, decreased sexual desire and function, decreasing bone density (possibly contributing to fractures), and decreasing cognition.
The current media blitz seems to focus on the middle aged man who might be getting a little depressed about his increasing weakness, decreasing sexual function, fatigue, and other problems. The implication of many ads is that replacing testosterone to normal levels will “rejuvenate” a man to lost health that he previously enjoyed as a younger man. A discussion of formal studies of the benefits of replacing low testosterone or low normal testosterone in men and women is complex and beyond the scope of this article. Suffice it to say that the studies include equivocal data, and also studies showing both positive and negative effects of supplemental testosterone.
How is testosterone administered? Previously, the most common way was via weekly injections, and these can be quite effective. (Oral intake of large doses is not preferred due to possible damage to the liver.) Later transdermal patches became available as well as various gels that can be applied to the skin. Each of these has its limitations and side effects. More recently a topical preparation became available that is applied to the underarms in a manner similar to applying a deodorant.
Like it seems for everything in medicine, supplementing your testosterone is not without risks. There may be risks to the prostate in men. Treatments for both prostate cancer and enlargement of the prostate can involve suppression of testosterone, so one might infer that replacing testosterone and increasing one’s levels would increase the size of the prostate and therefore symptoms, or increasing the growth of existing prostate cancer. Studies in these areas are mixed. Other risks might include liver damage (rare), polycythemia (overproduction of red blood cells), hair loss or excess growth, and even acne.
So if you’re a middle-aged man or woman and think you might be feeling your age a little in the energy, strength, or sexual desire and performance departments, should you consider testosterone supplementation? Maybe. Will it help? Maybe. Are there risks? Sure. As always, my recommendation is that you visit your primary care provider (PCP) to discuss your individual situation, because there is not a “one size fits all” recommendation. You do visit your PCP at least once a year, right? If indicated, measuring your testosterone level is a matter of a simple blood test. Deciding if low T is contributing to your symptoms, how to replace lost hormone, and balancing the risks and benefits can be complex and depends on your unique situation. In the right circumstances, testosterone can be safely supplemented and can lead to increased quality of life.
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (part of Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com