Low Testosterone Treatment: How to Know if You Need It

How to know if you have low testosterone
elderly man sitting on bed looking out window

If you believe the ads, increased testosterone levels through 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 older than age 40. Sales were around $2 billion in 2012, according to Consumer Reports.

But testosterone therapy isn’t for everyone and should not be taken lightly, says urologist Daniel Shoskes, MD.

Who needs testosterone therapy?

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

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

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

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Misinformation and overtreatment 

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

“Unfortunately, many people are being treated for low numbers and no symptoms,” says Dr. Shoskes. “Or people are being treated 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, so if you’re scheduling a test, do it before 11 a.m.

Unnecessary testosterone therapy comes with risks: a higher chance of blood clots, 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 testosterone 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. Other treatments that both raise testosterone and boost fertility are indicated.

The bottom line: Work with a urologist to make sure you really need testosterone therapy.

What about OTC natural remedies?

The market is booming with “natural” testosterone boosters, but don’t believe the hype.

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“There are really no such things as natural testosterone boosters,” says Dr. Shoskes. “It’s not a medical term and there really aren’t any substances that we know of that will boost testosterone.”

Testosterone boosters or supplements are sold with the aim of raising a man’s testosterone naturally, but only your urologist or endocrinologist should be administering any type of testosterone replacement.

“Many of these over-the-counter supplements aren’t safe because they’re not regulated by the Food and Drug Administration,” says Dr. Shoskes. “In the United States, what you buy over-the-counter may not even contain what it claims.”

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,” says Dr. Shoskes. “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 is you, be your own advocate with your urologist. There may be no ads for you, but there could be benefits from therapy.

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