A Handle on your Health: Should I be on testosterone treatment?
You may have driven by one of these clinics recently, “Low T Clinic” it reads or maybe you’ve seen a commercial for men’s testosterone therapy. If you’re a man and particularly an aging man you may have wondered to yourself what’s the deal with testosterone treatments. Is it safe? How do you get it? Is it expensive? Is it just another one of these gimmicks that doesn’t really work?
Lets first define what “Low T” is as most doctors define it. It is a syndrome with varying symptoms associated with a low testosterone level, usually below 300 ng/dl. But it must be stated here that there are different definitions depending on who you ask, so there really is no standard and in actuality there is quite a bit of controversy. Signs and symptoms include: fatigue, low sex drive, erectile dysfunction, obesity, loss of muscle mass, loss of bone density, memory or concentration difficulties, irritability or depression, and loss of body hair. While having these symptoms doesn’t mean you have low testosterone, it might mean you could benefit from an evaluation.
So what exactly is the doctor going to do when you come in with worries of low testosterone? They are going to ask you a series of questions about your health and your relative’s health, and then they will perform a physical exam. The next step is likely going to be some blood tests. The first priority isn’t to look for and diagnose low testosterone, but rather to make sure your problems aren’t coming from other possibly more serious medical conditions. Your doctor will want to evaluate you for heart disease, vascular disease, thyroid abnormalities, diabetes, hypertension, high cholesterol, alcohol abuse or smoking. Blood tests like a complete blood count (CBC), thyroid stimulating hormone (TSH), HgbA1c (tests for diabetes) and testosterone level may be ordered as well as some others. Your BMI (basal metabolic index) will be calculated to look for obesity. Bone density testing may be ordered to look for osteoporosis. It’s important to remember that the priority is to look for other diseases first before calling it “Low T.”
Now that other disorders have been ruled out and your testosterone levels have come back low, you will want to know what the treatment options are for “Low T.”
There are five ways you can be prescribed testosterone:
1. Weekly or monthly injections
2. Daily transdermal patches
3. Sublingual drops
4. Intranasal gel 3x a day
5. Implanted pellets every 3-6 months.
The pellet treatment is becoming more popular as it only requires a small incision into your buttocks or hip for the pellets to be placed 2-4 times a year. Each of these treatments has their pluses and minuses. Patches and creams can cause a rash. Injections hurt and can cause an injection site reaction. The pellets obviously require a small office procedure. At this point, you will go over these options with your doctor and decide which one is right for you.
However, there is controversy regarding the decision of when to treat “Low T.” Some of these “Low T” clinics will advocate treatment even if your testosterone levels are low normal but you have symptoms, and that has many specialists concerned. They are worried that “Low T” has become a trendy marketing tool just to sell drugs to men that may not need them. This is a serious drug that has the potential to help but also to harm if not used correctly.
As with any drug there are always risks of adverse effects and you need to know what they are. With the increased use of testosterone replacement there seems to be an increased risk of heart disease but evidence is mixed. Earlier studies showed a connection to coronary disease and death but more recent studies have actually shown no increase, so what is the truth? The truth is that more research is needed.
If you already have an enlarged prostate this treatment will likely make it worse. If you have prostate cancer you cannot take this drug. Patients can also develop high cholesterol or liver enzymes. As with heart disease, there is a possible increased risk for blood clots but the studies aren’t clear yet. Testosterone can increase the amount of blood you have which is a risk for a DVT (deep venous thrombosis). Your doctor should perform the necessary tests on you before starting therapy to make sure you’re a good candidate for testosterone therapy.
The take home message here is do your homework about testosterone therapy if it’s something you’re thinking about. “Low T” clinics can be very expensive. If you really think this condition is affecting you, you’re probably better off at your doctor’s office or a specialist. While marketing is telling you to go get checked for “Low T” realize that only about 2 percent of men probably have this condition. As we age into our 60s and 70s that percent might rise up to 10-20 percent. The point here is that if you’re not feeling as “manly” as you used to feel, don’t jump to the conclusion that it must be because of low testosterone. Have a conversation with your doc about it.
As always, feel better.
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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.
