Testosterone replacement therapy for men has exploded in recent years. Make no mistake about it, testosterone replacement therapy has become a big business venture for many medical offices, physicians and mid-level providers. Some reports suggest that 25% of men receiving testosterone are not actually deficient in the hormone and are not followed appropriately once testosterone replacement has been initiated.
What gets lost in the mix of all of this is that symptoms of testosterone deficiency are real and can affect men in many ways, ranging from their sex life, energy level and quality of sleep. Thus, low testosterone is certainly something men can and should be treated for, however, it needs to be done in the appropriate patient and monitored.
A total testosterone level of 300 ng/dL or less in a symptomatic man is considered low, and replacement therapy should be discussed. It is recommended that two serum testosterone levels be checked to make sure that levels remain low. For some, additional lab testing is necessary to rule out other reasons why testosterone levels are low, such as deficient chemicals in the brain.
Once it has been confirmed that testosterone levels are deficient, testosterone replacement can be initiated. For men over the age of 40, it is important to have a baseline PSA, as well as hemoglobin and hematocrit levels. Some patients will develop an overproduction of red blood cells while receiving testosterone replacement, which causes the blood to become too thick. Some men may need to periodically donate blood in order to keep blood levels within an acceptable range. It is important for routine blood work to be done every six to 12 months to monitor these lab values.
When it comes to how testosterone can be replaced, there are several options. There are topical gels, creams, as well as injections and pellets. Each have pros and cons to them, and for some patients their insurance can be used to cover some of the expense. Ultimately, the type of replacement chosen may be a patient or physician preference.
When it comes to testosterone replacement, there is a wealth of bad information on the internet. The fact is, there is a fair amount of controversy surrounding the treatment, but current recommendations still support its use in appropriately selected patients. Many physicians are concerned about potential risks of heart attacks and strokes as well as increased risk of prostate cancer.
Available literature has consistently shown that low testosterone levels are associated with an increased incidence of major adverse cardiac events, such as myocardial infarction, stroke and possible cardiovascular-related mortality. The relationship between testosterone therapy and the development of prostate cancer has been debated. While the U.S. Food and Drug Administration retains a warning regarding the potential risk of prostate cancer in patients who are prescribed testosterone products, there is accumulating evidence against a link.
Randomized controlled trials have shown there is not a significant increase in the rate of prostate cancer diagnosis in older, testosterone deficient men who were treated with testosterone compared to placebo.
In my opinion, testosterone replacement is a safe and important part of men’s health when administered appropriately and monitored correctly in selected patients. Testosterone replacement is not, however, a cure-all potion as it is sometimes marketed. It can certainly improve many parts of a man’s life, but unfortunately, it is not the fountain of youth.
If you are experiencing chronic fatigue, poor sex drive or an overall sensation of “not having any gas in the tank,” then perhaps a testosterone level should be checked on your next set of labs.