Testosterone: Is it the Male Fountain of Youth?

While many of us are making New Years’ resolutions to improve our health and take better care of ourselves, we may not be achieving these goals and wondering what is missing. I want to address some important male health issues this month, as a simple problem could be interfering with our desire to become healthier. The majority of my male patients are well aware that they need several lab tests including PSA and cholesterol, but they may not be aware of their testosterone level. The symptoms of low testosterone are so vague that most men will not even think to have it checked. These symptoms include, but are not limited to, low sex drive, impotence, fatigue, loss of facial hair, decreased muscle mass, depression, poor concentration, decreased sleep and weight gain. Some men just think they are tired and not getting enough sleep, never realizing that they need to be treated. It is important to have testosterone measured if any of those symptoms are present, but of no use if the symptoms are absent. The benefit of replacement can alleviate many of the above symptoms but certain precautions need to be taken as side effects can occur.
It is well known that testosterone decreases as men age, but it is not known how significant a problem this is. Testosterone itself is a naturally occurring hormone that is part of the male reproductive system and allows for proper development of male sex characteristics, including facial hair and muscle development. After age 40, testosterone drops about 1%-2% a year.
A few simple blood tests will help in the evaluation of testosterone level. A total testosterone level below 300 or a free level less than 50 is considered abnormal. These numbers are not related to age, even though many testing facilities will still consider low levels to be normal if the patient is older. That is a false assumption and should be taken into consideration if a lab report shows a testosterone of less than 300 being normal in an older patient. In addition, Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), will increase as testosterone decreases and should be measured. Blood count, PSA and a sleep study should all be done prior to starting replacement with testosterone.
Testosterone deficiency has been linked with sleep apnea, among other conditions, and this must be evaluated first before initiating replacement because sleep apnea can actually become worse if not treated when testosterone is started. Sperm count will be lowered so supplemental testosterone cannot be used if the patient wants to have children. The forms of testosterone supplementation include gels, patches, and injections. The gels need to be applied daily and are effective but can be messy and have an unpleasant odor. The patches are also used on a daily basis but can cause significant skin irritation. The injections need to be given every two weeks and may irritate the liver. Another gel can be applied inside the cheek but is also irritating to the mouth. While some of these medications do have side effects, the benefits of their use can dramatically improve the quality of life of the patient. Muscle mass will increase, weight loss may occur and overall sense of well being can be achieved. The goal is to find the right form of medication that the patient can tolerate and increase it to the proper level. The symptoms can be improved with replacement but it is not a causal decision and should be done with proper medical monitoring and counseling. If a man is concerned about any vague or abnormal symptoms that might be related to low testosterone, he should contact his physicians and discuss his options.