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Last Modified - 12/17/2010
Testosterone Replacement Therapy
Low testosterone is referred to by many different names such as hypogonadism,
andropause and androgen deficiency in the aging male (A.D.A.M.). These terms are
oftentimes used interchangeably and create confusion even amongst healthcare
professionals. All of these terms refer to a condition of low testosterone that is associated
with other symptoms. Some of these symptoms include a decreased sex drive, fatigue,
erectile dysfunction, falling asleep after dinner, memory and concentrating difficulties, bone
density loss and diminished work performance which are all associated with low
testosterone levels. Oftentimes these symptoms are overlooked or attributed to some other
condition such as normal ageing. Effective therapy for low testosterone levels exists.
Why is my testosterone level low?
It is a well known fact that a man's testosterone level begins to decline as early as the age of
thirty (30). In fact, large longitudinal population studies have shown that a man's
tetsosterone decreases by approximately 1% per year after the age of 30. By the time a man
reaches the age of 60, there is a 30% chance that he will have a low testosterone level.
Most often the decrease in testosterone is associated with aging. Similar to when a woman
goes through menopause, men go through andropause but at a much slower rate.
Consequently, many of the symptoms associated with this condition can be insidious.
What are some other conditions associated with Hypogonadism?
Certain common conditions are frequently associated with low testosterone. The following
table lists some of these conditions.
|Chronic Opiod Use
||Sickle cell disease
What are the risks of testosterone replacement therapy?
In general, testosterone replacement therapy is very safe. People oftentimes confuse the
difference between replacing testosterone in the body to return it to normal physiologic
levels with taking testosterone to achieve "super-physiologic" levels for performance
enhancement. These are clearly two different situations. The biggest concerns are related
to prostate health and the development of prostate cancer. Many hypogonadal men might
notice a slight worsening of their urinary symptoms or increase in their PSA. This occurs
because the prostate and PSA are directly controlled by testosterone. Replacing
testosterone into the normal range only increases urinary symptoms and PSA into the range
where they would be if the testosterone level was not low in the first place. Men with
testosterone levels in the normal range (300-1000 ng/dl) are at no greater risk of developing
prostate cancer than their hypogonadal counterparts. Hypogonadism is not only not
protective against prostate cancer, there is some evidence to suggest that hypogonadal
men might develop a more aggressive form of prostate cancer. Men on testosterone
replacement therapy appear to have improved angina-free exercise periods and better
cholesterol profiles than their hypogonadal counterparts. The risks of osteoporosis and
fractures are reduced in men on testosterone replacement therapy.
What are some of the other resources available to better understand my
For a more detailed discussion about hypogonadism and testosterone replacement
therapy, read Dr Karpman's article:
The Therapeutic Challenges of Hypogonadism and Its Comorbidities
Testosterone Replacement Therapy
Hormone deprivation therapy
may make prostate cancer
WebMD, August 31,2008
Lower testosterone in men
can lead to earlier death
Telegraph, June 17,2008
Testosterone link to
BBC News, March 4, 2008
increases death risk in older
(Urology Times, Nov 1, 2007)
Efficacy of changing
preparations in suboptimally
men. (Int J Impot Res, Sept
Low Testosterone May
Increase Mortality. (Renal &
Decline in testosterone
levels seen among American
men (Urology Times,
December 7, 2006)
TRT appears prostate-safe in
6-month trial (Urology Times,
Alerting your physician to any of the symptoms asssociated with low testosterone is
important. A health inventory questionnaire called the A.D.A.M questionnaire was designed
to identify patients who potentially might have low testosterone levels. If you answer yes to
any three questions or to any single sexual question, there is a strong possibilty that you
have a low testosterone level. Your physician will order confirmatory lab tests prior to
commencing any therapy.
What types of treatment options are available for men with low testosterone
There are a variety of treatment options available for the man with low testosterone levels.
Currently, there are oral, buccal, transdermal gels, patches, intramuscular injections and
subcutaneous pellets available to treat hypogonadism. Each form of therapy has specific
advantages and disadvantages associated with it. You can discuss with your physician
which form of therapy is right for you.