26 Jul 2019
Men how are you feeling? Most of us can find something to complain about, such as having less energy than we would prefer, decreased sex drive, less than optimal erections, perhaps even depressed mood. Some of these complaints are rooted in causes that we can control, such as unhealthy eating or overeating, lack of exercise, smoking, not getting enough sleep, etc. Many times, however, the cause is something that we cannot control: testosterone levels.Testosterone peaks around puberty and starts to decline gradually with age. Depending on a person’s genetics, this may happen earlier for some than others, at times as early as your 30s. You may find that your mood is depressed, there is no energy or drive to do the things you used to do (think: get motivated enough to build that deer stand in the heat of July in preparation for October), less interest in sexual activity, and lack of erection or inability to maintain one.As mentioned above these symptoms can have other causes, but a simple blood test can confirm the presence of male hypogonadism, or low testosterone (low T). It is best to draw these blood tests in the morning as testosterone levels peak in the morning hours, and it is recommended that at least 2 levels be drawn on 2 separate days. An accepted level for “normal,” is over 300 ng/dL, and anything below that is considered hypogonadism if it is accompanied by the previously mentioned symptoms. However this is not a firm cutoff. If your level is 301 and you have symptoms, a trial of replacement would still be reasonable. If both levels are low and symptoms are present, a trial of testosterone replacement is given.Replacement can take the form of injections (shots) given every 1-3 weeks, longer-acting injections given in the office every 10 weeks, topical gels or creams that are applied daily to the skin, and testosterone pellets injected under the skin every 3-5 months.The choice is up to the patient, and many patients switch from one method to another until they find what works for them.
So what is the goal? The goal is symptom relief, and this happens at different levels for different people, but the “normal” range is about 300-800 ng/dL. Ideally, one would maintain his testosterone level at 500-600 ng/dL all of the time. This is very difficult to do, and does not happen naturally in our bodies anyway. This means that with every delivery method mentioned above, there will be peaks and troughs. The testosterone will peak after you administer it, and it will slowly decrease to a trough (low level) until you give the next dose. The goal is to minimize peaks and troughs in order to avoid times in which symptoms are not being treated but also to avoid dangerous peaks that can cause side effects.
So what are the potential side effects? As mentioned above, mood can be adversely affected, and this can be seen with testosterone that is too low or too high.Testosterone replacement can also cause polycythemia, a condition in which there are too many circulating red blood cells.Red blood cells are helpful in keeping us alive, they carry oxygen from our lungs to the tissues and organs of our body, but too many can cause the blood to become too viscous or thick. The treatment for this may involve stopping testosterone therapy or decreasing the dose, or donating blood on a regular basis to the local blood bank. There is also some risk in men with prostate cancer or a history of prostate cancer and testosterone is generally avoided in these men. There is no current evidence to suggest that testosterone replacement causes a person to develop prostate cancer.Testosterone replacement can adversely affect sperm counts, and men who are attempting to conceive a child or plan to in the near future should consider avoiding testosterone replacement, but there are other options for these men.
So what if the testosterone is low and a man chooses to live with it? Low testosterone carries its own risk and set of side effects.Other than the previously mentioned symptoms, low T can be associated with loss of muscle and bone mass, loss of height, high blood pressure, high cholesterol, and obesity. Strong evidence exists that shows an increased risk of major adverse cardiac events such as stroke and heart attack in patients with low testosterone. So we are starting to see that this may not only be a quality of life issue, but may truly affect the health of many men.
If you think you may have these symptoms, consider speaking with your doctor about it or make an appointment to speak to one of our specialists at Regional Urology to discuss further.
Written by Jeremy Norwood, MD, Urologist at Regional Urology. He is currently seeing new patients at the Shreveport and Bossier City offices.