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Testosterone Replacement Therapy

By Eric A. Rudin, MD | Endocrinology, Diabetes and Metabolism

Testosterone replacement therapy has become very popular in recent years.  Symptoms such as low sex drive, depressed mood, poor concentration or decreased energy may all be signs of low testosterone.   As we all know, many of these symptoms become increasingly prevalent as we age.  Therefore, the idea of testosterone therapy is intriguing for many men.

Testosterone deficiency is diagnosed with an early morning testosterone check.  There are simple blood tests which your doctor may order if you have symptoms of low testosterone.   If your testosterone level is low, your doctor will do some confirmatory studies to try to determine if there are any correctable medical problems which could be resulting in the low level. Treating a low testosterone level may improve your libido, mood, bone density, muscle strength, and overall sense of well-being.

Since testosterone levels naturally decline with age, it is sometimes difficult to know whether or not to treat older men with a slightly low testosterone level.  I always make sure to bring my patients back after 3-4 months of testosterone therapy to assess the response to therapy.   If the testosterone levels normalize, but there is no improvement in patient’s symptoms, I recommend simply stopping therapy.

As with all medications, there are risks with taking testosterone.  In older men, testosterone therapy may result in increased risk for heart disease.  The therapy may also increase prostate size and the risk for prostate cancer.  Therapy can also increase hemoglobin levels which in turn can increase the risk for stroke and cardiovascular disease.  Finally, the therapy may also result in a slightly increased risk for blood clots.

Overall, testosterone therapy can be of value for certain types of patients. However, one must always measure that value against potential risks.