Low testosterone can be treated with testosterone replacement therapy, but there are pros and cons.
Millions of American men have low testosterone levels. Symptoms can include decreased sex drive, erectile dysfunction, depression, lack of energy, and loss of muscle mass.
If you’re concerned that you may have low testosterone, your doctor can check your testosterone level with a simple blood test. If you and your doctor decide that you need treatment, there are several options for testosterone replacement.
Goals of Testosterone Replacement Treatment
The overall goal of testosterone replacement therapy is to increase your testosterone level until it is in the middle of the normal range, which for an adult male should be between 300 and 1,000 nanograms per deciliter (ng/dL). What’s normal for you will depend on your age and your symptoms. Testosterone replacement therapy improves signs of masculinity — deepening the voice, increasing muscle mass, and prompting the growth of pubic and facial hair. It also relieves symptoms of low testosterone such as decreased sex drive, poor erections, low energy, and depression.
Testosterone replacement is not recommended as a way to improve your sexual or athletic performance, enhance your looks, or prevent aging. You should have testosterone replacement treatment only if you’ve been diagnosed with low testosterone by a doctor and you’re taking it under a doctor’s prescription and supervision.
Testosterone Replacement Treatment Options
Testosterone replacement therapy can take the form of gels, injections, transdermal patches, and tablets that dissolve under your lip. Each type of testosterone replacement is effective, and each also has advantages, disadvantages, and side effects.
- Testosterone replacement injections. Depo-Testosterone (testosterone cypionate) and Delatestryl (testosterone enanthate) are forms of testosterone replacement therapy given by injection. The advantages of injectable testosterone are that you take it only once every one to two weeks and it’s relatively inexpensive. The disadvantage is that testosterone levels may be difficult to control — too high just after your injection and too low just before the next injection.
- Testosterone replacement gels. Testosterone gel preparations — AndroGel and Testim — are the easiest testosterone therapy to administer and have been shown to be very effective in several studies. Testosterone gels must be applied to the skin on your arms or shoulders about the same time every day. Disadvantages are the higher cost, possible irritation to sensitive skin areas or your eyes, and the possibility that the medication can rub off on someone else.
- Testosterone replacement patch. A testosterone transdermal patch called Androderm is applied to the skin each night and left in place for 24 hours. You’ll need to pick a not-too-hairy spot on an arm, your stomach, or your back, and choose a different spot every night. The main disadvantage to using the patch is skin irritation.
- Testosterone replacement using a tablet under the upper lip. Striant is a testosterone tablet that you place under your upper lip against your gum (a so-called buccal system) and replace every 12 hours. You don’t chew or swallow these tablets, which mold to your upper gum so you can eat and drink normally. Disadvantages of the buccal system include irritation of the gums, toothache, and bitter taste.
Side Effects of Testosterone Replacement
In addition to the short-term side effects of the different testosterone replacement options, there are longer term side effects common to all testosterone replacement treatments:
- Enlargement of the prostate gland
- Breast swelling and tenderness
- Increased urination and fluid retention
- Worsening of breathing problems during sleep, such as sleep apnea
- Weight gain
- Increase in red blood cells
Testosterone Replacement Cautions
In most cases, testosterone replacement for low testosterone is safe and effective. However, you should not use testosteroone replacement if you have certain medical conditions.
Although there is no evidence that testosterone replacement therapy causes prostate cancer, it can cause an existing cancer to grow more quickly. You shouldn’t take testosterone replacement if you have prostate cancer, male breast cancer, or if your prostate has been diagnosed as being abnormal through a rectal exam or by a blood test. So be sure your doctor rules out these illnesses before starting any treatment.
If you have a medical condition that causes you to produce an excess of red blood cells or if you have untreated sleep apnea, you may not be able to take testosterone replacement.
Low testosterone is a diagnosis that can only be made by your doctor and treated under medical supervision. If you’re being treated for low testosterone, make sure to keep regular doctor appointments and let your doctor know if you have any side effects.