UCI Health Men's Health specialist Dr. Faysal Yafi.
Many misconceptions surround testosterone replacement therapy, but if low testosterone is properly diagnosed and managed, treatment can improve men’s overall health.
Low testosterone has generated a lot of buzz in recent years. It even received a nickname — “Low T” — from one of the pharmaceutical companies that makes a treatment for it.
Testosterone therapy misconceptions
The most common question men ask me about testosterone replacement therapy is whether there’s a cutoff age. They’re concerned that they might be too old.
This is just one of many misconceptions flying around about testosterone therapy — and no, there is no cutoff age. Other misunderstandings involve studies that appeared to indicate possible side effects, such as an increased risk of heart problems.
Mostly, the rumors about the dangers of testosterone come from cases of abuse — men who were taking high doses of the hormone to artificially enhance their sports performance or build exaggerated muscles. Another danger has been doctors who don’t specialize in men's health giving prescriptions without determining first that testosterone levels were low, or failing to follow up on how their patients are doing.
For the men whose testosterone levels are abnormally low, to the point where their well-being is affected, responsible replacement therapy can provide real help. When prescribed after blood tests that confirm low testosterone levels are at the root of men’s problems, and with regular follow-up by their doctors, testosterone therapy doesn’t just alleviate symptoms but also improves overall health.
Two types of low testosterone
Low testosterone levels can affect men of any age, but especially older men. When levels become low enough to cause symptoms, it is no longer a normal part of aging but a real medical condition called hypogonadism.
There are two types of hypogonadism:
- Primary. In primary hypogonadism, the problem lies with the testes, which fail to produce enough hormone.
- Secondary. Secondary hypogonadism comes about when the hypothalamus or pituitary gland malfunctions; the result is a lack of signaling to the testicles to produce adequate testosterone.
In either form, the problem can stem from illnesses, genetic conditions, trauma and surgery — or simply from aging.
Symptoms of low testosterone
Low testosterone symptoms include:
- Fatigue and reduced sexual drive
- Problems with concentration and sleep
- Decreased facial and body hair
- Increased fat around the abdomen
- Loss of muscle mass
- Bigger breasts
- Changes in mood and concentration
- Lower bone density — which may lead to fractures
When to seek testosterone therapy
How do you know when to see a doctor? That’s easy: When symptoms become bothersome.
Often, the symptoms that drive men to seek treatment are erectile dysfunction, decreased libido and depression. They think they need Viagra or a similar erectile dysfunction medication, but a blood test will reveal low testosterone levels, which may be contributory.
Other times, men come to me thinking that hormone replacement will solve their mood and sexual problems, but they might have additional psychological issues that need to be addressed first.
My job is to ask open-ended questions and listen carefully to the answers. Yes, my patient might need testosterone therapy, but he also might have depression that has little to do with his hormone levels. He’ll get a prescription, but also a referral to a mental-health therapist who can help him in other ways.
Is testosterone therapy safe?
Testosterone replacement therapy got a bad name after four studies linked it to higher incidence of cardiovascular problems. But those studies had some flaws and at least one of them has since been amended multiple times. Meanwhile, more recent studies have found testosterone therapy to be safe and potentially protective to the heart in men who need it.
Another concern patients have is that testosterone might be linked to prostate cancer, because it does raise levels of PSA, or prostate specific antigen, a protein used as a marker of tumor growth in the prostate. But research shows that once testosterone levels reach a certain point, they no longer have an effect on prostate cancer development when they rise higher.
Current evidence shows that testosterone therapy is safe in some patients who have prostate cancer, although this is something that should be discussed at length with your doctor. Men with an abnormally high red blood-cell count, severe sleep apnea and certain other conditions aren’t candidates for testosterone.
That’s why it’s important to have a full physical exam and a long talk with a urologist who specializes in andrology — men’s health.
Low testosterone treatment options
There is no FDA-approved pill for testosterone replacement, but there are several other options:
- A topical ointment that must be applied to the skin every day
- Shots that a patient can be trained to give himself
- Pellets that can be placed under the skin through a tiny incision and that last about three to four months
Each type has its advantages and disadvantages that you should talk through with your doctor.
Men who are taking testosterone should be checked on an ongoing basis to ensure that their hormone levels are staying within range and that their health and overall well-being are on the right track. Your doctor should be providing continuing care in order to make sure that testosterone replacement is safely doing everything it can for you.