Testosterone replacement therapy | Valley Health – Mat-Su Valley Frontiersman

Testosterone levels begin to decline in men at about 40 years of age. Testosterone levels drop about 1% per year- unlike the rapid, dramatic decline in estrogen that women experience at menopause. Over time, the decline is significant and can be clinically important. However, at least 75% of older men continue to maintain their levels within the normal range. Among men that would benefit from testosterone therapy, the Institute of Medicine estimates that only 5% are on treatment.

Symptoms of a low testosterone may include changes in sexual function including reduced sexual desire, fewer spontaneous erections and infertility. It is rarely the cause of erectile dysfunction. Even among men with low testosterone that have erectile dysfunction, only a very small number see this improve with testosterone therapy. Other symptoms include, decrease in muscle mass and strength, decrease in bone density, anemia (low numbers of red blood cells) and increase in body fat. Some men may also experience depression, decreased motivation and a decline in their memory.

Testosterone levels vary by time of day. The highest levels are at 8 am. The normal range for testosterone is based on blood tests draw at 8 am. Therefore, if you have your levels drawn to evaluate your need for therapy, make sure they are drawn at 8 am. Low values are defined as levels below 200 ng/dL. If you value is low, a second level is required to confirm the diagnosis and to qualify you to have your insurance company pay for therapy. Testosterone is a controlled substance and its use is tightly regulated by the Food and Drug Administration. You must have clearly abnormal values in order to qualify to receive treatment.

A small number of men experience immediate side effects including: acne, breast enlargement or tenderness and swelling in the ankles. Red blood cell counts may also rise that increase your risk of blood clotting. Finally, testosterone can worsen sleep apnea a condition that causes severe snoring and cause you stop breathing for short-intervals during the night. You should not start testosterone if you have sleep apnea and are not on treatment for it.

Long-term complications may include an increase in healthy prostate tissue cause symptoms of obstruction. It does not cause prostate cancer, but is cancer is present, it will stimulate it to grow. Finally, there are concerns that testosterone may cause an increase in heart attacks, strokes and death from cardiovascular disease. The data on this are mixed and large scale studies are currently underway in an attempt to see if it truly increases the risk of cardiovascular disease and death.

Your therapy is monitored at 6-month intervals with blood tests for testosterone levels, blood counts and cholesterol levels. Prostate specific antigen (a protein that reflects the amount of prostate tissue) is monitored annually looking for an increase in prostate tissue both healthy are cancer. You may require further evaluation if this level rises too far or too fast. With proper monitoring, testosterone therapy can be safe and effective.

Dr. Samuel Abbate is a local physician practicing in Wasilla.

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Testosterone replacement therapy | Valley Health - Mat-Su Valley Frontiersman