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The pros and cons of testosterone therapy

Created date

May 24th, 2017
syringe and medical vials

Testosterone, the hormone that directs male appearance and healthy muscle, bone, and sexual function, declines as we age. Levels of this hormone drop about 1% each year beginning at about age 30. This does not sound like much, but 30% of men in their seventies and 50% of men in their eighties have low testosterone levels. Given that the decline naturally occurs with aging, should low levels in seniors be addressed? Is it safe to treat octogenarians with testosterone? Should we even measure testosterone levels?

These questions have been asked for decades among medical professionals and we have learned much from clinical studies, which can guide our decision-making. The T trials, a series of seven linked investigations, offer insights, but ultimately decisions about taking male hormone replacement therapy must be made at a personal level between patient and doctor.

Here’s some of what we know: Low testosterone levels, often referred to as hypogonadism, can cause symptoms such as fatigue, depression, and diminished sex drive and functioning. They may also contribute to osteoporosis, decline in muscle mass and cognitive function, and anemia.

The T trials and other studies, in general, demonstrate that testosterone treatment for individuals with low levels generally improves sexual function, anemia, mood, and bone and muscle mass but does not significantly improve strength, walking distance, cognitive function, or vitality. 

There are clear potential benefits associated with treating men with very low levels of testosterone, but is it safe? Very real concerns exist about the safety of treating low testosterone levels with hormones, particularly at more advanced ages. The two primary risks that researchers have focused on are cardiovascular disease and prostate cancer. For heart disease, the data is mixed and inconclusive with some studies showing an increased risk of heart disease and others showing safety. For prostate cancer, again, we have not yet defined the level of risk or safety. We do know that prostate cancer is often testosterone dependent, and that lowering testosterone levels is often a fundamental part of cancer treatment; thus, the inference that raising levels may accelerate growth of a potential cancer is a real concern. 

What to do 

Given the complexity of this subject, the first step is to have the discussion with you doctor, review your symptoms, understand what might be contributed to by low testosterone levels, and understand your risks. If you would rather have your current symptoms than take risks as described above, you may elect not to even check your testosterone level. If you and your doctor would potentially consider testosterone treatment and believe your symptoms may be related, the next step may be to check a level. But please do not take the hormone without having several lab tests to confirm your testosterone is low. 

If you do elect treatment, which can be given in the form of injections, gels, implants, or patches, it is essential to monitor your prostate and cardiovascular health as well as your blood count, cholesterol, and testosterone levels. 

While we have learned much about testosterone and its role in health and well-being, many questions remain. Decisions about treatment must be made carefully and in close dialogue with your physician. 

Dr. Narrett leads the medical team at all Erickson Living communities. A graduate of Harvard Medical School, he has been providing care for seniors for over three decades.