Q: I am a 45 year old man.  I was experiencing tiredness and low sex drive.  My doctor checked my testosterone level, and it came out low-normal at 350.  Should I take Testosterone?

Testosterone replacement therapy has certainly become a rage.  It is being touted as a miracle drug promising increased vitality, sex drive and energy.  The number of men with prescriptions for testosterone has climbed rapidly over the past few years. In fact, the number of older and middle-aged men prescribed this hormone has tripled since 2001.  This raises an important question – who really needs testosterone replacement therapy?

Testosterone replacement therapy is approved specifically for the treatment of abnormally low testosterone levels, a condition called hypogonadism.

In men, normal testosterone levels range from 300 to 1000 nanogram per dl, and begin a gradual decline after the age of 30. But testosterone levels, even under normal circumstances, can fluctuate greatly depending on various factors. Some studies estimate that up to 30 percent of men ages 40 to 79 have a true deficiency, though only a small percentage actually develop clinical symptoms.

The symptoms of low testosterone are varied. Fatigue is a common symptom of low testosterone. You may also notice: decreased sex drive, depressed mood, decreased sense of well-being, difficulties with concentration and memory, erectile dysfunction, hot flashes and sleep disturbances. There are also studies showing that men with low testosterone levels have shorter life spans and an increased risk of diabetes, heart disease and osteoporosis.

The effects of low testosterone can go unnoticed for years. The consensus is that if a man does not have any symptoms, he should not even be tested. However, if you have symptoms, and have a low testosterone level, you may benefit from replacement therapy. Men with symptoms of low testosterone can have significant improvement in their quality of life with testosterone replacement.

There are several options available for testosterone replacement. These include:

·     intramuscular injections.

·     Testosterone patches worn on the body.

·     Testosterone gels that are applied daily to the shoulders or upper arms.

·     Underarm gel application.

·     Pellets implanted in soft tissues.

Each of these options provides adequate levels of hormone replacement. Each has its advantages and disadvantages. Intramuscular injections are cheaper and require less frequent administration compared to the other options but produce wider swings in hormone concentration, with higher levels shortly after the injection and lower levels just before the next injection is due. They may also produce increases in red blood cell count that are higher than normal.

The body patches may produce skin irritation in a significant number of men, requiring discontinuation of the patch. The gels require daily application and precautions to make sure that the hormone is not accidentally transferred to another person or partner.

Notice that there are no oral formulations available of Testosterone since they may produce liver abnormalities.

The choice of hormone replacement therapy is best made after a thorough discussion between you and your physician.

It is also important to realize that testosterone replacement can haveside effects. Acne is a fairly common side effect. It can cause prostate enlargement resulting in symptoms such as difficulty urinating. It is recommended that a PSA level be checked periodically while on Testosterone. Most men will also see their testicular size shrink, and it can also lead to a decrease in sperm count and even infertility. A distressing side effect could be breast enlargement due to the unopposed effect of estrogen. An increase in red cell count can happen with Testosterone, especially the injections, which sometimes requires phlebotomy. There is also some recent evidence of increased cardiovascular risk for people on testosterone.

People who take testosterone should follow up with their physician regularly so that some of the above mentioned side effects can be addressed.

Therefore, to answer your question, in the presence of symptoms (fatigue and low sex drive), with a low testosterone level, Testosterone is certainly an option for you.  Close monitoring by a health care provider is essential to assess benefits and risks.

This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He can be reached at 9037850031, orSucharu.prakash@usoncology.com