Testosterone Replacement – An Ongoing Debate

Guest post by Natan Bar-Chama, MD, Director of Male Reproductive Medicine and Surgery at The Mount Sinai Hospital, and Associate Professor of Urology at the Icahn School of Medicine at Mount Sinai.

Men in middle age face some of the same physical issues that women do. Men also find themselves gaining weight, feeling a lack of energy, being depressed and/or experiencing a decreased sex drive. These symptoms can be due to various causes: diabetes, obesity, depression, work marital, or relationship stresses or thyroid dysfunction. But sometimes these problems are due to low levels of testosterone, a condition called hypogonadism, caused by a problem in the testicles or pituitary gland. It is estimated that 1 in 4 men over 60 have low testosterone.What is testosterone? Testosterone is the male sex hormone, and accounts for the changes boys go through at puberty: proliferation of body hair, deepening of the voice, development of muscles and growth of the penis and testes. As men pass their 30^th birthday, their levels of testosterone begin to gradually decline (around 1% yearly). A normal testosterone range is 300 -800 nanograms per deciliter or ng/dl. Women make testosterone too, but men make much more.

It is hard to avoid print and television ads urging men to ask their doctors if they have “Low T”. For over a decade, testosterone supplementation has been promoted to men as a “fountain of youth” with claims that it can restore vitality, facilitate weight loss and improve sex. The problem with these claims, is that for the most part, they have not been proven. And men who do not have a clinically proven lowered level of testosterone will not notice any benefits from testosterone therapy.

And, importantly, the long term side effects of testosterone have not been tested, The most serious concerns include heart attack and the development of prostate cancer, though studies for both have been inconclusive. Testosterone supplement packaging does include a “black box” warning that it can cause blood clots in the veins (A black box warning is the strictest warning put on the labels of prescription drugs or drug products by the Food and Drug Administration when there is reasonable evidence of an association of a serious hazard with the drug).

Does hormone replacement work for men with diagnosed low testosterone?

This past February, the National Institute on Aging and the NIH released initial results of trials testing hormonal therapy in older men. They found that restoring testosterone levels to those of healthy young men did improve sexual function in men 65 and older with clinically diagnosed low testosterone. It had a smaller effect on walking ability and perceived vitality. More trials are ongoing, but this finding holds assurance for men who are weighing the benefits and risks of supplementation.

The Department of Urology at Mount Sinai has several experts who can assess symptoms of potential testosterone deficiency and make an accurate diagnosis -ruling out testicular or pituitary disorders – and recommend treatment plans according to the cause.

For those men feeling like they have lost a little of the “zip” they had a young adult, and whose testosterone falls within normal range, the Mount Sinai team advises trying lifestyle changes. Maintaining a healthy weight, eating a diet rich in fruits and vegetables and lean protein and getting regular exercise is a good start. “These three things alone can do wonders for increasing energy, in and out of the bedroom,” says Dr. Natan Bar-Chama, Director of Reproductive medicine, as well as promote weight loss, increase muscle tone, and manage stress, He adds, “That’s a great payback for the investment of a pair of sneakers”