By age 30, men begin to lose testosterone at a rate of 1 to 1.5 percent per year, says Patrick Mills, MD, a urologist with Urology Centers of Alabama. By age 50, 30 percent of men are already below the normal range and that statistic increases as years advance. “There has been an emphasis on female preventive care and health for years. We now know that this decrease in testosterone corresponds with a woman’s estrogen decrease. All of a sudden we have ‘male menopause,’” he says, “and people are more in tune to it.”
Testosterone is responsible for the proper development of male sexual characteristics and also is important for maintaining muscle bulk, adequate levels of red blood cells, bone density, sense of well-being, and sexual and reproductive function. “Men suffering from Low T may complain of symptoms that may include decreased sex drive, decreased sense of well-being, depressed mood, difficulties with concentration and memory, erectile dysfunction, and fatigue,” Mills says. “Probably every man will go through some or all of these issues at some point.”
Changes that occur as a result of Low T can include a decrease in muscle mass with an increase in body fat, variable effects on cholesterol metabolism, a decrease in hemoglobin and possibly mild anemia, osteoporosis, a decrease in body hair, and development of Type 2 diabetes.
Risk factors for Low T include some medical conditions that are prevalent in our society, Mills says, such as high blood pressure, diabetes, obesity, and high cholesterol. “People over age 50 often have one or more of these diagnoses,” he says.
Most surprising, Mills adds, is the high number of men under the age of 40 who are on chronic pain management and are developing Low T because of the treatments. “The exact mechanism of action is unknown, but we have a large number of chronic back pain patients who often have testosterone levels that are 70 percent below normal.”
Once a patient is diagnosed with Low T, the hormone will never level out by itself, Mills says. “Exercise, eating healthy and losing weight can improve testosterone levels some, but if it is very low it won’t come back on its own,” he adds.
For those patients, hormone replacement may be an option. Simple blood tests are used to measure a patient’s testosterone levels and to monitor the effects of the replacement therapy. There are several ways to deliver the therapy:
- Intramuscular injections, generally every two or three weeks. “There are several downsides to these shots,” Mills says. “They cause testosterone levels to rise quickly and then to drop off rapidly. Also, the patient must go to a doctor’s office every two to three weeks to get the injection. Unfortunately for older men, the shot is generally the only therapy covered by Medicare.”
- Testosterone gels that are applied daily. “The gels are dispensed from a lotion bottle with a metered-dose pump. The patient rubs the gel on his shoulder, side or inner thigh and it is absorbed through the skin,” Mills says. “Dosage can be adjusted by phone, and patients don’t have to go to a doctor’s office like with the shots. The gel tends to provide more stable hormone levels and usually is better tolerated.”
- Testosterone patches worn on the body. “We haven’t used the patches in years. Typically, they irritate the skin over a prolonged period of time and generally are not well tolerated,” Mills says.
- Testosterone pellets. “The pellets are inserted under the patient’s skin in a simple, five-minute procedure in the doctor’s office. The pellets deliver a steady dose of testosterone for three to four months so the patient only has to go to the doctor’s office about three or four times a year for insertion,” Mills says. “The pellets keep the hormone levels stable and are more convenient for patients.”
Mills says that the goal for testosterone replacement is to improve a patient’s quality of life without raising testosterone levels too high. “I try to set realistic expectations. I want to help the patient understand that I cannot make him feel like he is 20 years old again,” Mills says. “We want to improve his energy level and sex drive and make him generally feel better. Low T also is associated with osteoporosis in men, so the prevention provided by the therapy is another benefit of hormone replacement.”
Mills is glad to see that many men now are taking more responsibility for their health care. “We rarely see health centers specifically for men like we currently have for women, but that is changing as chronic male conditions such as Low T come to the forefront,” he says. “These issues are part of the natural aging process, and as men become more proactive in their health care, their quality of life will improve with proper treatment.”