More Men Inquiring about Their Testosterone Levels

You may have seen the television commercials that tell men they may have low testosterone, or low T, if they are feeling tired or have a low sex drive. 

As a result of this aggressive, direct-to-consumer television advertising, more men are requesting to have their testosterone levels tested.

Dr. Meijuan Yan, an endocrinologist at Penn Medicine Lancaster General Health Physicians Diabetes & Endocrinology, says over the past several years she has seen an influx of men requesting a testosterone test. She says it’s a nationwide trend.

“I think it’s definitely the result of television advertising,” says Yan. She adds that because there’s more testing done, there have been more diagnoses of low testosterone.

Testosterone is a hormone integral during male puberty. It puts hair on a male’s chest, deepens his voice, builds his muscles, and boosts the size of his penis and testes. In adulthood, it keeps a man’s muscles and bones strong and maintains his interest in sex.

After age 30, however, most men begin to experience a gradual decline in testosterone.

A recent study by the New England Research Institute revealed that 1 in 4 men over the age of 30 have low testosterone levels, but only 1 in 20 have clinical symptoms linked to such a deficiency.

Signs of low testosterone may include depression, difficulty concentrating, declining muscle and bone mass, increased body fat, fatigue, lower sex drive, erectile dysfunction, and loss of body hair.

Those symptoms, however, also are very common to men over the age of 50.

While the pharmaceutical companies promote testosterone replacement therapy, it may not be appropriate for everyone with low testosterone. According to the commercials, testosterone replacement therapy can make men feel more alert, energetic, mentally sharp, and sexually functional.

A Journal of the American Medicine Association study linked the television commercials to greater testosterone testing and new use of testosterone therapies for men who likely weren’t appropriate candidates for treatment.

“It’s important to look for the root cause of the decline in testosterone,” stresses Yan. “Many men think that if they’re tired, they have low testosterone. There can be many reasons for being tired. Sleep apnea, malnutrition, poor health, and obesity can all contribute to being tired.”

Yan says some men may be born with genetic factors that cause low testosterone. Low T also can be temporary.

Other factors that affect low testosterone may include depression, diabetes, coronary heart disease, high blood pressure, opioid use, or loss or harm to the testicles.

“If the cause for low testosterone is irreversible, testosterone replacement therapy is usually appropriate,” says Yan. “But if the cause is reversible, we try to correct the root cause first.”

Blood tests should be ordered to determine a man’s testosterone level. A second blood test should be conducted to confirm low testosterone, according to Yan.

“Just having low testosterone isn’t enough to require testosterone replacement therapy,” she says. “Many men want to take testosterone to reverse reductions that are normal results of aging. You need symptoms to be on testosterone replacement therapy. We don’t treat numbers; we treat people.”

According to the American Urological Association, testosterone replacement therapy should only be prescribed to men who meet the clinical and laboratory definition of testosterone deficiency. 

The Endocrine Society recommends in the absence of symptoms, men 65 or older with low testosterone levels alone shouldn’t routinely be prescribed testosterone replacement therapy.

While testosterone replacement therapy can be beneficial, it also can have long-term complications, such as a higher risk of heart attacks, strokes, and deaths from heart disease. Some men also may experience acne, rashes, disturbed breathing while sleeping, breast swelling or tenderness, and swelling in the ankles.

Men with prostate cancer, uncontrollable heart disease, or heart failure should not be on testosterone replacement therapy, according to Yan.

After starting therapy, which may last a lifetime, Yan says men need to follow up with their physician periodically to have their testosterone levels checked and undergo other lab tests to make sure the therapy is not causing other problems.

There are several different forms of testosterone replacement therapy. Gels or injections are the most popular. Gels are applied once a day and are absorbed directly through the skin. You must be sure the gel is fully absorbed and the skin dry before anyone can touch that area.

Testosterone can have a negative effect on women and babies. It can harm a pregnant woman’s developing fetus. It also can cause the development of masculine characteristics in women and children.

With injections, testosterone is injected directly into the muscles. Pellets, about the size of a grain of rice, are one of the newest forms of testosterone replacement therapy. They are implanted under the skin and supply a low dose of the hormone for up to six months at a time. 

If testosterone replacement therapy is recommended, what should expectations be?

“Men need to be realistic,” says Yan. “Testosterone replacement therapy is not the fountain of youth. Some men actually feel worse on testosterone.”

Karen Herbst, M.D., Ph.D., an endocrinologist at University of California – San Diego, specializes in testosterone deficiency. She estimates about 1 in 10 men are “ecstatic” about their response to testosterone replacement therapy, while about the same number “don’t notice much.” She says the majority have generally positive, but varying, responses to testosterone replacement.

Yan encourages men who have questions about their testosterone levels to consult an endocrinologist.