David Bryan, M.D. 's Urology Blog

The truth about Testosterone in the aging male.

The process of aging typically results in a gradual, progressive decline in function of the testicles.  The age of onset and the trajectory of decline is highly variable.  The syndrome, known as andropause (compared to menopause in our female counterparts), has become increasingly recognized and treated over the past decade.  Unlike female menopause, which is fairly predictable and abrupt in onset, this is more insidious.  The prevalence of hypogonadism in men over 45 years old has been estimated at 39%.  It manifests itself in a number of ways.  Decreased libido, erectile dysfunction, loss of body and facial hair, weakness, fatigue, increased body fat and decreased bone density are some of the most common manifestations.  Hypogonadism is defined as 2.5 standard deviations below the mean (average) normal Testosterone value in found adults, or roughly 300 ng/dl.  It is important to note that hypogonadotropic men interested in fertility require special evaluation and stimulation of their pituitary axis, as simply supplementing with exogenous testosterone can further impair spermatogenesis.  Testosterone should be measured in the am, as it has a circadian rhythm.  Total T is sufficient for screening.

Risk of Prostate Cancer?  Fact or Fiction?

There is also a myth that supplementing Testosterone can increase the risk of prostate cancer.   This has been largely debunked, by Shabsigh et al, who demonstrated in a meta-analysis of 44 studies, that there is no correlation between testosterone replacement and increasing the risk of PCa or increasing the risk of higher grade tumors.1  However, prior to therapy, men should be screened for the presence of prostate carcinoma, because there is unequivocal evidence that T can stimulate growth and aggravate symptoms in men with locally advanced prostate cancer.

Treatment

There are various ways to supplement low testosterone.

1. Intramuscular injections – these are long actin and reach a max. concentration in 72 hours.  They are normally administered every 2-4 weeks, and do not have a circadian pattern to them.
2. Topical Therapy – there are a variety of topical gels/creams available.  These include products like Testim, Androgel, Axiron, Fortesta.  These require daily applications to upper abdomen, chest, or upper arms, avoidance of showers for 2-4 hours, and avoidance of skin-to-skin contact with other persons during that window.  They can be costly, but most insurance companies will have one on formulary and most manufacturers offer discount cards to help with co-pays.
3. Implantable Pellets – Timed release pellets placed under the skin in a 5 minute office procedure.  They typically last 3-6 months.

If you are concerned about low testosterone, or would like to discuss treatment options, contact your doctor or call my office.