November 20, 2013
We’ve all been bombarded by the ads on TV of sad middle-aged men that are tired. Tired and they can’t get erections and have a decreased libido (sex drive). Then there’s a promise of a virtual “fountain of youth” in the form of a daily gel applied to the underarm, groin, or shoulders…sometimes all three. Sad man turns into happy, newly moustached, fully-restored man that can now throw a football again.
Low Testosterone is not a new medical diagnosis, but there just so happens to be four relatively new brands of testosterone gel, all vying for your (or your insurance company’s) dollars, hence the deluge of direct-to-consumer advertisements.
It’s important to remember that Low Testosterone is a lab value. If your testosterone is found to be abnormally low and you have symptoms, you could be a candidate for testosterone replacement therapy. Amazingly, over 25 percent of men prescribed testosterone replacement have not had their blood testosterone levels checked!
The symptoms of low testosterone include decreased libido, erectile dysfunction, difficulty recovering from exercise, decreased muscle mass, and decreased energy or “get up and go.” As you can see, many of the symptoms of low testosterone overlap with other unrelated conditions.
If you’re meeting with your primary care physician for an annual physical, do not assume that testosterone will part of the normal panel of labs. This is a separate, specific test done only in situations of men that are symptomatic. If you do have your lab work done, make sure to have your T checked within three hours of waking. This guarantees an accurate reading when your T is at its highest (there’s a scientific explanation for morning wood!) Usually there are follow up labs to determine if there is any other correctable cause to the low testosterone.
There are several potentially harmful side effects to testosterone replacement therapy. These may include fueling the growth of prostate cancer, worsening urinary symptoms related to enlarged prostate, and potentially an increased risk of cardiovascular disease. The effects of treating large populations of men with testosterone has not been extensively studied. In addition to the physiological side effects, testosterone gel is usually pretty expensive, so keep that in mind if you’re considering therapy.
As much as there is controversy to diagnosing and treating men with low testosterone (for good reason) some men truly benefit from carefully directed therapy.