Is testosterone therapy right for you?
Growing evidence shows that the majority of men who have been placed on testosterone therapy should not have been treated with this medication. Both the Food and Drug Administration (FDA) and the American Urologic Association (AUA) have released recent publications stating only men with hypogonadism and symptoms of low testosterone should be treated with testosterone therapy.
The diagnosis of hypogonadism is established when a man has had at least two early morning testosterone blood levels that fall below the normal range of the laboratory used for the testing. Men with “low normal” testosterone levels should not be treated with testosterone therapy.
In response to the pharmacy industry’s aggressive marketing of testosterone, the FDA has issued new regulations curbing the marketing of testosterone for “low T” or andropause: a term coined to reflect the normal decreasing levels of testosterone in the aging male. Furthermore, drug companies are now required to clearly label testosterone replacement products with the appropriate usage of these medications. Testosterone therapy should not be given to enhance physical performance or for body-building. Men with an interest in fertility currently or at any time in the future should not be treated with testosterone. Testosterone causes decreased sperm counts that may not improve after stopping the drug.
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Unfortunately, there are many men who have been treated with testosterone therapy in the past for unclear indications who are now dependent on the drug. When men are treated with testosterone, the body senses the higher testosterone levels the drug produces and testicle function is impaired. If testosterone therapy is discontinued, the testicles often don’t bounce back and function normally. Hence these men are committed to life-long therapy they didn’t need in the first place.
Testosterone therapy has both beneficial and adverse effects on men. On the good side it often improves muscle mass, energy levels and libido. It typically does not improve erectile quality. Adverse side effects include acne, breast enlargement, nipple tenderness, increased red blood cell counts, testicle shrinkage, swelling of the feet and ankles and an increased risk of cardiovascular disease. The relationship between prostate cancer and testosterone replacement is unclear at this time.
It is very important that men treated with testosterone are followed by a physician who understands the implications of testosterone therapy. Testosterone is not a benign medication. Regular follow-up appointments and routine lab testing are necessary to make sure no complications of this therapy arise.
Men can often improve testosterone levels through lifestyle changes rather than starting testosterone therapy. A 5 percent reduction in total body weight has been shown to significantly improve testosterone levels in men. A regular exercise regimen composed of at least three 30-minute sessions of weight lifting and cardiovascular exercise weekly correlates with improved testosterone levels too. Improved regular sleep patterns have also been shown to improve testosterone levels.
If a man has worsening energy levels or declining libido he should be appropriately tested for hypogonadism. If testosterone levels are low, the man should initially work on weight loss, a regular exercise regimen and improving sleep patterns. If these changes are not working and testosterone therapy is necessary, make sure the man is followed by a physician who will actively manage this therapy appropriately.
Dr. John Greer is a board-certified urologic surgeon who specializes in male infertility. He is a founding member of Idaho Urologic Institute. Dr. Greer is a member of the American Urological Association, the Idaho Medical Association, the Ada County Medical Society and the American Society for Reproductive Medicine. Dr. Greer completed a fellowship in Male Reproduction and Infertility at Baylor University. He is also a diplomate of the American Board of Urology.