Testosterone supplementation in aging men is becoming more prevalent as we all live longer. Many previously undiagnosed conditions have become more common, and this is the situation for men with low testosterone. Simultaneously, we have become better at measuring changes in our blood chemistries and more demanding in our desires to feel well and perform better.
Thus, the medical diagnosis of “late-onset hypogonadism” probably affects 2 to 4 million American men. Treatment is given to only about 5% of men with this condition and even this low rate represents a substantial increase in the percentage of men treated over the past few years.
Just as women undergo menopause, men can undergo male menopause or andropause. Specific signs and symptoms in older men include a decrease in muscle mass and strength, a decrease in bone mass with the onset of osteoporosis, and an increase in central fat. Namely, the older male body changes shape as we get shorter and fatter. Not fun to talk about, see in the mirror, or look forward to, but nonetheless reality.
Symptoms such as decreased libido and sexual desire, forgetfulness, loss of memory, anemia, difficulty in concentration, insomnia, and a decreased sense of well-being are more difficult to measure and differentiate from normal aging and andropause, according to an excellent review by Bassil, Alkaade, and Morley entitled, “
The Benefits and Risks of Testosterone Replacement Therapy: A Review.”
Testosterone declines at about 1% per year, starting gradually at age 30. Over the ensuing decades, the rate of decrease accelerates. By age 80 over 30% of men are in the low range by laboratory tests. However, just being in the low range doesn’t make a diagnosis nor necessarily require treatment.
Having symptoms of low libido, erectile dysfunction, fatigue, poor energy level, difficulty concentrating, depression, irritability, low sense of well-being, and other less well-defined conditions are necessary for the diagnosis. Again, and importantly, just having a laboratory abnormality is not enough to necessitate replacement therapy. Treating the patient and not the lab is an old clinical saw which has held up well even as we have easier availability for a myriad of tests.
There are benefits and risks to treatment, which is usually the case with any medical condition. Benefits include improved mood, better energy, a positive sense of well-being, better sexual function, greater muscle strength, and progression towards a leaner body mass. Bone density improvement and increased red cell count have also been observed.
Cognitive function, namely the ability to think, solve problems, and have a better memory, has been examined in relation to testosterone levels in the blood. No definitive correlation was found between poor memory and low testosterone, although the studies were relatively small and of short duration. Unfortunately, using testosterone replacement as a treatment for Alzheimer’s disease was also unsuccessful.
Last month, a study of 5,246 men in the
New England Journal of Medicine showed the use of testosterone supplementation does not increase the risk of heart attacks.
Nothing is without risks in medicine. There are always pros and cons to taking any medication, but in general, avoiding unnecessary medications is wise. However, symptoms of low testosterone combined with objective laboratory confirmation should be the first two specifics recognized, even before thinking about taking additional testosterone therapy.
The science of medicine is always evolving and now faster than ever. Stay tuned as more research findings are published about testosterone. In the meantime, let’s all remain open-minded about risks and benefits.