Testosterone, the primary sex hormone in men, is known for causing physical changes in boys during puberty. Many are not aware that it can also affect sex drive, mood, muscle mass and bone density.
Testosterone levels tend to drop in all men as they age. In fact, according to research, about 4 out of 10 men over age 45 have low testosterone, or "low T." In honor of Men's Health Month, we asked Dr. Robert Eisenberg, a urologist affiliated with Sharp Grossmont Hospital, some questions about this common condition.
How do men get low T? Is it preventable?
It is possible, but not common, for pituitary and testicular issues to cause low T; most men get it as they age. More specifically, they get low "free testosterone" — the active, unbound form of the hormone. Studies show those with chronic health conditions like high blood pressure, diabetes, coronary artery disease and obesity are more likely to get low T.
As far as prevention, like most things, a lifestyle that promotes good cardiovascular health may promote normal testosterone levels. This includes things like a heart-healthy diet, exercise, not smoking, and blood pressure monitoring and control.
Are there any health risks associated with having low testosterone?
Most of the health impact of low T affects quality of life: decreased libido, moodiness/depression, decreased strength or muscle volume, low energy levels and decreased short-term memory. These symptoms can have a profound effect on a man's life and should be evaluated if present.
What are some treatment options for patients with low T? What are the benefits or risks of these?
There are many available options for testosterone replacement, including topical gels and patches, injections and long-acting testosterone supplements. Although there are some risks:
- Topical gels can stay on clothes and be absorbed into the clothing. Those using gels must take care to keep it from being transferred to others via direct skin contact.
- Testosterone supplements may increase PSA (prostate-specific antigen) levels, causing men with large prostates to experience worsening of symptoms. PSA levels should be checked before and after starting treatments, as a rise in PSA levels could indicate underlying prostate cancer.
- In the past, there were concerns regarding testosterone supplementation and increased cardiovascular risk, but more recent research has not shown that risk. Research in this area is ongoing, so cardiovascular health should be discussed with your doctor before treatment.
- Testosterone replacement causes infertility, so it should not be used in a patient trying to get pregnant.
What symptoms are indicative of low T, and when is it time to call the doctor?
Men with symptoms of low T — decreased libido, erectile dysfunction, low energy levels, grumpy mood and poor memory — should be evaluated by their doctor or referred to a men’s health specialist. Low testosterone can cause severe symptoms that can have a significant impact on quality of life.