‘Low T’ Therapy: Do You Need It?

Get the facts on testosterone treatment

Older man with doctor

If you believe the ads, testosterone therapy will make you sexier. More muscular. More energetic. More likely to drive a cool car.

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The messages about low testosterone, or “Low T,” seem to be taking hold. A new study published in JAMA Internal Medicine says prescriptions tripled between 2001 and 2011 for men over age 40. And sales were around $2 billion in 2012, according to Consumer Reports.

But testosterone therapy is not for everyone and should not be taken lightly. Cleveland Clinic urologist Daniel Shoskes, MD, offers insight on who can benefit from therapy — and who should avoid it.

Who needs it?

“Low testosterone is not a disease on its own,” Dr. Shoskes says.

There’s no normal number for everyone. A man can have low testosterone — determined by a blood test — and still be fit physically, mentally and sexually.

That’s why there are two parts to diagnosis. One is the number, and the other is the symptoms. Men with testosterone deficiency syndrome, or androgen deficiency in aging men (ADAM), often have poor libido, erectile dysfunction, decreased muscle mass, fatigue, mental fogginess and depression. Those symptoms have many possible causes, though. A trial period of treatment and monitoring is often the only way to confirm a diagnosis.

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“Having Low T and one or two symptoms doesn’t mean one is causing the other,” Dr. Shoskes says. “We treat for a few months to see if symptoms improve and your testosterone level comes up.”

A few mistakes lead to unnecessary treatment. One is misinformation — and maybe a little pressure from men who view testosterone therapy as a fountain of youth.

Misinformation and overtreatment

A few mistakes lead to unnecessary treatment. One is misinformation — and maybe a little pressure from men who view testosterone therapy as a fountain of youth.

“Unfortunately, there are many people being treated for low numbers and no symptoms,” Dr. Shoskes says, “or people who have symptoms and no low number. The two really need to go together.”

Faulty testing can cause problems, too. Blood should be drawn in the morning when a man’s testosterone is at its peak. If you’re scheduling a test, do it before 11 a.m.

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Unnecessary testosterone therapy comes with risks: a higher chance of heart attack or stroke, mood swings and aggression, and urinary symptoms, to name a few. Men with metastatic prostate cancer, untreated sleep apnea or severe urinary problems should not have therapy. Neither should young men hoping to start a family. Contrary to popular belief, it doesn’t boost fertility. In fact, it can lower sperm count and cause infertility.

The message: Work with a urologist to make sure you really need testosterone therapy — and many men do — before pursuing it.

It can be undertreated, too

Buried among the news about overtreatment is a surprising fact: Sometimes low testosterone is undertreated. “There are large numbers of men who would benefit but are not being tested,” Dr. Shoskes says. “There are no ads for them.”

Chronic conditions such as HIV/AIDS, diabetes and kidney failure often coincide with low testosterone. But many men with these conditions are never tested because their symptoms can easily be blamed on their main diseases.

If this applies to you, be your own advocate with your urologist. There may be no ads for you, but there could be benefits from therapy.