Lakeview Health System
Low Testosterone in Men

Testosterone is a hormone produced by the testicles and is responsible for the proper development of male sexual characteristics. Testosterone is also important for maintaining muscle bulk, adequate levels of red blood cells, bone growth, a sense of well-being, and sexual function.As a man ages, the amount of testosterone in his body gradually declines. This natural decline starts after age 30 and continues throughout life. Other causes of low testosterone levels include injury to the testicle, chemotherapy or radiation for cancer, genetic causes, medications (especially steroids and hormones), alcohol, chronic liver or kidney disease.

The significance of testosterone decline is not clear, since many conditions associated with low Testosterone can occur with other conditions.  However, low Testosterone has been linked  with decreased libido (sexual desire), erectile dysfunction, depression, sleep problems, decrease in muscle mass, osteoporosis, changes in cholesterol and a decrease in hemoglobin.:

The only accurate way to detect the condition is to have your doctor measure the amount of testosterone in your blood. It is best to test levels  in the morning since this is when testosterone levels  highest.  It is unclear if testing the total Testosterone or the free Testosterone is most accurate.

It is important understand that Testosterone deficiency should only be treated if there are symptoms of Testosterone deficiency and there is a documented low Testosterone on the blood test.

Testosterone replacement therapy is considered safe when done with supervision, but some cautions should be noted.  Testosterone is considered the precursor growth hormone for the prostate so increased levels can make the prostate grow, which can cause some urinary changes.  While Testosterone replacement will not cause prostate cancer, men who have or are suspected to have prostate or breast cancer should not take testosterone replacement therapy. Men who may want to father more children also should not take testosterone, since the sperm count is affected.   Also, testosterone replacement has been associated with acne, sleep apnea and an increase in the hemoglobin (red blood cell count) so it is to be  used with caution in those who have had certain types of strokes or with certain blood conditions where the hemoglobin is high.

All men considering testosterone replacement therapy should undergo a thorough prostate cancer screening prior to starting this therapy with a rectal exam and PSA test.  It is typical for the physician to monitor Testosterone, Hemoglobin and PSA levels of all men on Testosterone replacement therapy.

Testosterone can be given a number of ways. Unfortunately it is not considered safe or effective to give Testosterone pills.  The most common ways for replacement include intramuscular injections, every 2 weeks, a daily gel or patch, or a long acting subcutaneous implant every 4-6 months.

Each of these options provides adequate levels of hormone replacement; however, they all have different advantages and disadvantages. Talk to your doctor to see which approach may be right for you.

-Tom Stormont, MD