We are drowning in testosterone ads and new products. Every major pharma is pushing its new product for testosterone (T) replacement. Most are transdermal gels (AndroGel, Testim and others) to be applied to various parts of the male body (including the armpit), one or two are patches (Androderm), not to mention a variety of testosterone preparations for intramuscular injection. There are ads on TV, on your computer, in your mailbox. It’s as bad as the pharma wars between Motrin and Naprosyn in the old days when nonsteroidals were new therapy. Men, are you getting insecure?
The Physiological Issue
Yes, there is a real issue that affects some men. In midlife and later, our hormone systems can falter, and we can become mildly or substantially deficient in testosterone. That can lead to sexual difficulties both in lower libido and reduced ability to generate and sustain normal erections, but at least as important may also result in loss of energy, a feeling of lower vigor and robustness, and reduced physical strength.
Your doctor’s dilemma is that there are truly many other physical and psychosocial issues that may cause those same sexual and physical symptoms, many of which have nothing to do with testosterone. And even testosterone insufficiency may come from primary faltering of testicular function or from failure of the stimulating hormones that originate in the brain and pituitary gland. We are pretty complex organisms.
What to Do for Diagnosis?
First, we need some data. Since some of the symptoms, especially fatigue and lack of vigor, have multiple possible causes and may start up in a subtle fashion, we are now regularly testing our men for testosterone levels at annual checkup time. The tests include total and free testosterone levels. The same tests are also done (possibly with a few other relevant hormone levels) at any visit if the man indicates significant symptoms of new origin.
Second, I am talking much more specifically with each man about these issues since the final determinant of whether therapy may be indicated is how the man feels, weighed against his measured testosterone levels. Biology is complex, and many men feel and function completely normally with statistically low testosterone levels, while other men may be symptomatic and possibly respond to supplemental testosterone even with moderately high serum levels. This can certainly be an issue for a couple, not just the man.
What to Do for Therapy?
Finally, if a man appears to be symptomatically affected by low testosterone levels, we undertake a therapeutic trial to raise his T and determine if his symptoms improve with higher serum levels. We typically start with transdermal testosterone gels, or the patch, but may use intramuscular testosterone every 2 weeks or so as a rapid method to raise levels. In no case do we treat to the baseball players’ supranormal and probably harmful levels of testosterone. This is replacement therapy to restore normal function.
Each of you is unique, so please speak up yourself about energy and sexuality if I don’t ask you first at your next checkup.