A Harvard Specialist shares his Ideas on testosterone-replacement Treatment
It might be said that testosterone is what makes men, men. It gives them their characteristic deep voices, big muscles, and body and facial hair, differentiating them from girls. It stimulates the development of the genitals , plays a role in sperm production, fuels libido, and leads to normal erections. It also fosters the creation of red blood cells, boosts mood, and assists cognition.
As time passes, the "machinery" which produces testosterone slowly becomes less powerful, and testosterone levels start to drop, by approximately 1 percent a year, beginning in the 40s. As men get into their 50s, 60s, and beyond, they may start to have signs and symptoms of low testosterone such as lower sex drive and sense of vitality, erectile dysfunction, decreased energy, reduced muscle mass and bone density, and anemia. Taken together, these signs and symptoms are often called hypogonadism ("hypo" meaning low working and"gonadism" speaking to the testicles). Researchers estimate that the condition affects anywhere from two to six million men in the United States. Yet it's an underdiagnosed issue, with just about 5 percent of these affected undergoing therapy.
Various studies have shown that testosterone-replacement therapy may offer a wide range of benefits for men with hypogonadism, including enhanced libido, mood, cognition, muscle mass, bone density, and red blood cell production. But little consensus exists about what constitutes low testosterone, when testosterone supplementation makes sense, or what dangers patients face. Much of the current debate focuses on the long-held belief that testosterone can stimulate prostate cancer.
He has developed particular expertise in treating lower testosterone levels. In this interview, Dr. Morgentaler shares his perspectives on current controversies, the treatment plans he utilizes his own patients, and why he thinks experts should reconsider the possible connection between testosterone-replacement treatment and prostate cancer.
Symptoms and diagnosisWhat symptoms and signs of low testosterone prompt that the average man to see a doctor?
As a urologist, I tend to see guys since they have sexual complaints. The main hallmark of reduced testosterone is low sexual libido or desire, but another may be erectile dysfunction, and some other man who complains of erectile dysfunction should possess his testosterone level checked. Men can experience other symptoms, like more trouble achieving an orgasm, less-intense orgasms, a lesser amount of fluid from ejaculation, and a sense of numbness in the penis when they see or experience something which would usually be arousing.
The more of these symptoms there are, the more probable it is that a man has low testosterone. Many physicians tend to discount these"soft symptoms" as a normal part of aging, however, they are often treatable and reversible by normalizing testosterone levels.
Are not those the very same symptoms that men have when they are treated for benign prostatic hyperplasia, or BPH?
Not precisely. There are a number of medications that may lessen sex drive, such as the BPH drugs finasteride (Proscar) and dutasteride (Avodart). Those drugs may also decrease the quantity of the ejaculatory fluid, no question. However a reduction in orgasm intensity normally doesn't go along with therapy for BPH. Erectile dysfunction does not usually go together with it either, though surely if a person has less sex drive or less interest, it is more of a challenge to have a fantastic erection.
How can you determine if a person is a candidate for testosterone-replacement treatment?
There are two ways we determine whether someone has reduced testosterone. One is a blood test and the other is by characteristic symptoms and signs, and the correlation between these two methods is far from ideal. Generally guys with the lowest testosterone have the most symptoms and guys with highest testosterone possess the least. But there are a number of men who have reduced levels of testosterone in their blood and have no symptoms.
Looking at the biochemical amounts, The Endocrine Society* considers low testosterone for a total testosterone level of less than 300 ng/dl, and I believe that's a sensible guide. However, no one quite agrees on a number. It is similar to diabetes, where if your fasting sugar is above a certain level, they will say,"Okay, you've got it." With testosterone, that break point isn't quite as clear.
| *Notice: The Endocrine Society publishes clinical practice guidelines with recommendations for who should and shouldn't receive find more information testosterone treatment. Is total testosterone the ideal point to be measuring? Or should we be measuring something different? Well, this is another area of confusion and good debate, but I do not think that it's as confusing as it appears to be in the literature. When most physicians learned about testosterone in medical school, they learned about total testosterone, or all of the testosterone in the human body. But about half of the testosterone that is circulating in the blood is not readily available to the cells. It is closely bound to a carrier molecule called sex hormone--binding globulin, which we abbreviate as SHBG. The available part of total testosterone is known as free testosterone, and it is readily available to cells. Almost every laboratory has a blood test to measure free testosterone. Though it's just a small fraction of this total, the free testosterone level is a pretty good indicator of reduced testosterone. It is not ideal, but the correlation is greater than with total testosterone. This professional organization recommends testosterone therapy for men who have both
Therapy Isn't recommended for men who have
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