When men are young,
testosterone tends to get a bad rap, often blamed for aggressive and overly
competitive behaviour. But as men get older, the bad rap continues, though for
a different reason.
In older men, it's low
testosterone that has captured attention.
Testosterone, the male
hormone, plays a vital role in many body functions, and low testosterone levels
can leave men tired, uninterested in sex, infertile and with thinning bones,
according to the US National Library of Medicine.
It's also a fairly common
problem in older men. As many as 4 in 10 men older than 45 have lower than
normal levels of testosterone, according to the American Urological
But, replacing lost
testosterone isn't a panacea, despite what you might have seen on TV.
"There's been a lot of
advertising, and every guy that comes in now asks about testosterone,"
said Dr Ryan Terlecki, a urologist at Wake Forest Baptist Medical Centre in
Winston-Salem, N.C. "They've been led to believe that it's a fountain of
youth, but it's not a cure-all."
For example, many men hope
that testosterone therapy will help treat erectile dysfunction. But, Terlecki
said that though testosterone is a treatment for low libido and taking
replacement testosterone may increase a man's sex drive, it's not a direct
treatment for erectile dysfunction.
also isn't an option for men who want to preserve their fertility. That's
because when a man takes testosterone therapy, the testosterone receptors in
the body tell the brain that there's enough testosterone, and, in turn, the
brain signals the testes to stop producing sperm.
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Not for cancer patients
Men who have active
prostate cancer or male breast cancer also aren't candidates for testosterone
However, other men with
symptoms of low testosterone may want to consider it. For starters, that
includes men who "might notice a drop in energy and low libido",
Dr Steven Canfield, chief
of urology at the University of Texas Health Science Centre at Houston, said symptoms of low testosterone that men might notice also include "the
development of breast tissue, a loss of body hair, small or shrinking
testicles, no need for shaving, flushing, sweats and bone loss."
But, he said, there are
less specific symptoms, too. Men with low testosterone might also notice
"a decrease in self-confidence, feeling sad or depressed, problems with
sleeping, memory problems, reduction in body mass, and a decrease in work
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A simple blood test
All it takes to tell if a
man's testosterone level is low, he said, is a simple blood test.
Although low testosterone
is common in older men, it's not necessarily a normal part of ageing. Other
conditions that are common with ageing, such as obesity or depression, can cause
lower levels of testosterone, according to research presented at the Endocrine
Society meeting in Houston this year.
Canfield said that
testosterone levels can drop if testicular tissue is lost, which can happen with
age. And Terlecki said that prior testicular trauma, undescended testicles and
radiation treatment to the testicles also can cause lower testosterone levels.
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Several options exist for
treating low testosterone. For men who want to keep their fertility, Terlecki
said, the drug clomiphene can be prescribed. In men for whom that's no longer
an issue, testosterone replacement therapy can boost testosterone levels.
Options for testosterone
replacement, Canfield said, include injections, patches, a gel and implantable
pellets. He said that a pill form of testosterone is available in other parts
of the world, but not in the United States.
Injections are given once
every two weeks, Terlecki said. The downside to this option is that injections
provide a large dose of testosterone in the beginning but it drops fairly
Topical formulations, such
as testosterone gel, are put on in the morning and absorbed within two to six
hours and, if used consistently, provide a steady consistent dose of
Patches can provide a
longer-term steady dose of testosterone, but they may cause irritation,
Terlecki said. And implantable pellets, according to Canfield, can provide a
steady, long-acting dose of testosterone. They're injected just underneath the
skin on your backside during an outpatient office procedure. Risks of testosterone therapy
Risks of testosterone
therapy include an increase in the size of the prostate, water retention,
worsening sleep apnoea, a lower sperm count and an increase in the platelet
count, which could increase the risk for blood clots, according to Canfield.
Both men agreed that
testosterone therapy won't solve all male health issues.
"The most important
thing men need to know is that testosterone therapy isn't a substitute for
taking care of overall health," Terlecki said. "A lot of men come in
obese, with a poor diet and no exercise, and they want to blame low
testosterone. While testosterone may play a role in their overall health, it
needs to be viewed in context with these other factors."
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