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Is testosterone replacement therapy a good fit for you?

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There are both risks and benefits to the hormone treatment

COURTESY: PROVIDENCE - Dr. Ruben Halperin, a general internist with Providence Health & Services.If you listen to the radio frequently, or if you channel surf on your home television, you've probably heard a commercial touting the benefits of testosterone.

If you're considering testosterone replacement therapy as the magic pill to make you a new man, perhaps in the bedroom, consider the advice of a local doctor.

Dr. Ruben Halperin, a general internist with Providence Health & Services, said testosterone is the primary male hormone that gives men their secondary sex characteristics, such as muscle bulk and facial hair. It also contributes to libido, or sex drive.

"As men get older, there is a natural decrease in testosterone levels," Halperin said, noting that, when it comes to the idea of giving men testosterone to make them feel young again, results are mixed.

"Everything we do there are risks and benefits," Halperin said. "So most of the time, the advertising will talk about things like strength, endurance, libido, improved erections. There's actually not a lot of good data for most of that."

Halperin continued, "The best data for treating men with testosterone is for improving libido. Testosterone has a strong effect on libido." He added, however, that it's not the only factor and it's hard to predict if a certain level of testosterone in the blood will boost libido to a desired level. "For men who are having trouble achieving erections, low testosterone isn't usually the main issue and replacing testosterone is rarely beneficial as the only treatment for erectile dysfunction."

Aside from sexual issues, Halperin said there have been trials looking at replacing testosterone as a way to help build muscle bulk and bone strength to treat or prevent weakness in older men, "but there's no clear evidence on how helpful this can be in protecting against falls and fractures, or improving endurance."

There is controversy as to whether it's safe to give men testosterone.

"You'll be disappointed to find out that nobody actually knows the answer to that," Halperin said. "About 3 years ago, there was a study that came out of the Veterans Administration that suggested that men who got testosterone replacement were at increased risk of heart disease. There was a lot of criticism of how that study was done."

Halperin pointed out that other studies have shown the opposite: men with low testosterone are at an increased risk of heart attacks, or increased risk of diabetes.

"The true answer is it's just not known whether supplementing somebody with testosterone is dangerous or whether it's safe," Halperin said.

However, if you have prostate cancer and considering testosterone, it's vital you consult with your doctor.

"There's also, at least, a theoretical risk (with testosterone) of increasing the risk of prostate cancer or, if people have prostate cancer, of making it grow faster," Halperin said. "If you're going to start somebody on testosterone, part of the protocol is to check their prostate and check the PSA (a blood test for prostate cancer) to make sure it's not elevated - the feeling is if you were going to put somebody on testosterone, you want to make sure they don't have an obvious prostate cancer."

There are cases where younger men need testosterone. "Some men, even when they're younger, have medical problems that affect their ability to make testosterone," Halperin said. "Most of the time, in those cases, people have, sort of, catastrophic things happen, where their body shuts down and stops making testosterone completely. In those cases, they're usually young men and we absolutely replace their testosterone because, if you're in your 20s or your 30s, you should have pretty healthy levels of testosterone. Without it, it's going to have a lot of effects on men, sort of, in the prime of their life."

It's always a good idea to bring up the subject of testosterone replacement with your doctor. Halperin added, "In my practice, there are some men that I've given testosterone to for various reasons, and I think, like any other medication, you have to evaluate the patient and weigh the risks and benefits."

MORE ON TESTOSTERONE THERAPY

Testosterone is a hormone produced primarily in the testicles. Testosterone helps maintain men's:

  • Bone density
  • Fat distribution
  • Muscle strength and mass
  • Facial and body hair
  • Red blood cell production
  • Sex drive
  • Sperm production
  • What happens to testosterone levels with age?

    Testosterone levels generally peak during adolescence and early adulthood. As you get older, your testosterone level gradually declines — typically about 1 percent a year after age 30 or 40. It is important to determine in older men if a low testosterone level is simply due to the decline of normal aging or if it is due to a disease (hypogonadism).

    Hypogonadism is a disease in which the body is unable to produce normal amounts of testosterone due to a problem with the testicles or with the pituitary gland that controls the testicles. Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men. Doctors may prescribe testosterone as injections, pellets, patches or gels.

    What are the risks of testosterone therapy for normal aging?

    Testosterone therapy has various risks. For example, testosterone therapy may:

  • Contribute to sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts
  • Cause acne or other skin reactions
  • Stimulate noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer
  • Enlarge breasts
  • Limit sperm production or cause testicle shrinkage
  • Increase the risk of a blood clot forming in a deep vein (deep vein thrombosis), which could break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism)
  • In addition, testosterone therapy may impact your risk of heart disease. Research has had conflicting results, so the exact risk isn't clear yet.

    Should you talk to your doctor about testosterone therapy?

    If you wonder whether testosterone therapy might be right for you, talk with your doctor about the risks and benefits. Your doctor will likely measure your testosterone levels at least twice before discussing whether testosterone therapy is an option for you.

    A medical condition that leads to an unusual decline in testosterone may be a reason to take supplemental testosterone. However, treating normal aging with testosterone therapy is not currently advisable.

    Your doctor will also likely suggest natural ways to boost testosterone, such as losing weight and increasing muscle mass through resistance exercise.

    — Mayoclinic.org


    Scott Keith is a freelance writer with the Portland Tribune and the Pamplin Media Group. If you have a health tip, or a story idea, contact Scott at: This email address is being protected from spambots. You need JavaScript enabled to view it.