Are you a shadow of who you used to be? Is your sex drive abysmal? Would your wife instantly be more attracted to you if your testosterone levels were higher? This is what ads hyping “Low T” testosterone replacement therapy are prompting men to consider.
The villain: low testosterone, or ‘Low T’, a phrase employed by clinics selling their “cure,” complete with improved mood, energy levels, libido, erectile function and vitality.
“These are targeted toward a specific audience, and that audience is men in their forties and up who are concerned about the potential effects of low testosterone,” said Dr. Karan Shukla, of Novant Health Randolph Family Medicine in Charlotte. “They market it as an easy fix when, in fact, it may not be so easy to fix.” By the same token, there may be much easier solutions, Shukla added.
Here’s what men should really know about testosterone levels and growing older.
The gradual decline of testosterone levels is normal.
“The anti-aging movement has been something that has been in our minds since the dawn of time,” Shukla said. But: “As part of the aging process, we see testosterone levels decline. Our peak testosterone levels are generally at around age 20 to 30, and after age 30 they decline more gradually. And more progressively after age 40. By age 80, almost all men see a marked reduction in serum testosterone levels.”
The symptoms of low testosterone vary – it’s not all about sexual function.
“We see some of the adverse effects of low testosterone on our physical health, our physical stature, our sexual health and our cognitive health,” said Shukla, who also specializes in sports medicine.
While lower sex drive and erectile function can be part of it, men with low testosterone can also experience symptoms like reduced body hair, increased fatigue, decreased lean muscle mass and depression.
In most cases, testosterone treatments are not the best option for these symptoms.
“A lot of medical conditions can contribute to low testosterone levels,” Shukla said. “It’s important to make sure that you’re not dealing with any underlying health issues. You want to really identify why you’re experiencing those symptoms.”
As he likes to frame it, maintaining your health is like maintaining your house. “If you don’t take care of the bones of the house, you can't expect to add on to the house or put a lot of investment in the house.”
Diabetes, kidney disease and a sedentary lifestyle could be contributing factors to these symptoms, as well as other chronic diseases.
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Even what’s going wrong in the bedroom has better fixes than testosterone replacement therapy.
While this is the most common concern that prompts the conversation about low testosterone among patients, Shukla said, “For erectile dysfunction specifically, phosphodiesterase inhibitors or medications in the class of Viagra or Cialis are generally much more effective than testosterone replacement therapy in achieving and maintaining erections.”
Make sure you’re tested by a medical professional before you make treatment decisions.
“People who are experiencing low testosterone need to be evaluated for primary and secondary hypogonadism,” Shukla said. That’s the name for the condition in which the testes, or testicles, aren’t producing as much testosterone. “It’s really important to do the testing and comprehensive evaluation with a qualified medical doctor prior to initiating treatment because you want to make sure that you are giving yourself the appropriate type of therapy that will help, not hurt you.”
Testing is usually administered through a series of blood tests to check nonfasting morning serum testosterone levels.
Testosterone replacement therapy is only recommended when the testes are shown to be producing low levels of the hormone.
If a patient is exhibiting signs or symptoms of low testosterone combined with demonstrably low testosterone levels, Shukla said, therapy with synthetic, chemically modified analogs of testosterone may be recommended. “Treatment may be provided with testosterone gel, transdermal patches or intramuscular injection.”
The intramuscular injections are popular because they’re the cheaper option, especially when pharmaceutical coupons are available.
“Regardless of how you administer it, the important part is follow-up,” Shukla said. He recommends bloodwork to check blood counts, liver function, kidney health, prostate levels, testosterone levels and other health indicators.
Even if you’re prescribed testosterone replacement therapy, you don’t use it forever.
In a medical setting, Shukla said, “The goal of testosterone replacement therapy is to improve the symptoms of the physical, sexual and cognitive health of an individual with the aim being to keep testosterone levels in the mid-to-normal range.”
As for how long you receive the therapy? “It can change depending on your health status and what your goals are,” he said, “and whatever stage of life you’re in.”