What You Need to Know About Low T
Tuesday, July 16, 2013

Dr. Greg BaroneIt is impossible to watch a sporting event on television or listen to an hour of sports talk on the radio now without seeing or hearing an advertisement for testosterone replacement. The ads are certainly appealing. Lose weight, improve energy, melt belly fat, improve sexual function, improve mood … sounds like a wonder drug. It would seem that most, if not all, men would find some value in “boosting” their testosterone levels.

But several questions have to be raised. What does it really mean to have low T? Who should be treated? And what are the potential risks and benefits of treating low T?

There are many, though rare, medical conditions in which the body is incapable of producing testosterone from the testes. Most of these are genetic conditions, present very early in life, affecting either the testes directly, or the pituitary gland in the brain, which generates the control signals for testosterone production. These are men that will not develop normally through puberty. Replacement of testosterone is clearly beneficial for muscle development and general well-being.

What is less clear is when to replace testosterone for men who have already completed puberty: the target audience for all those commercials. Testosterone has many important roles in the body: as the predominant male sex hormone, it is crucial to sex drive and erectile function. Testosterone gives men distinguishing characteristics: facial hair, deep voice, muscle bulk, bone strength. In addition to sexual dysfunction, lack of testosterone generally leads to a number of vague, sometimes non-specific, symptoms, such as fatigue, depression, weight gain, poor concentration, and sometimes even hot flashes.

Several studies have shown a natural decline in testosterone with age. As many as 50% of men over age 80 have testosterone levels less than 325 ng/dl. Physicians who treat low T understand that this remains an under-diagnosed condition. Yet there is still not a clear consensus regarding treatment. One of the limitations is the lack of measurable improvement. Most clinical trials rely on subjects saying they feel better in certain aspects, which is difficult to quantify. Most studies agree that restoring normal testosterone, in patients who are deficient, improves libido, improves energy, and improves mood. There has been a measurable improvement in bone strength, but no clear improvement in prolonging life, decreasing cardiac disease or decreasing cancer.

Risks associated with testosterone replacement must be weighed against the potential benefits. Testosterone stimulates prostate growth, so men with prostate enlargement or prostate cancer could see a significant worsening of their condition. Some forms of testosterone replacement have been linked to liver damage. There is a risk of the body forming too many red blood cells (polycythemia). Testosterone replacement can also worsen obstructive sleep apnea--a common condition in men with low T. Treatment will tend to be life-long. Once testosterone is replaced, the body will no longer attempt to stimulate the testicles to produce it, leading to testicular atrophy and potential infertility.

Current recommendations by the American Association of Clinical Endocrinologists are to treat men with confirmed low testosterone and evidence for clinical symptoms. But there are a number of other factors to consider. So if you have any questions about low T, schedule an appointment with your doctor.

Dr. Gregory Barone practices Endocrinology, Diabetes, and Metabolism with Kennedy Health Alliance in Cherry Hill. To reach him, please call 856-406-4091 or click here to visit the Kennedy Health Alliance website.