| FEATURE |
Testosterone Replacement Therapy
Is it Right for You?
Men with a low sex drive, fading energy, mood changes and erectile dysfunction may have low testosterone levels, also known as low-T. However, these symptoms can be caused by other reasons (multi-factorial). Ongoing research is trying to determine what symptoms go with low-T. So while there are a variety of medications to treat low-T, not everyone is a candidate, according to Charles Welliver, MD, Assistant Professor of Urology at Albany Medical College.
What is Low-T?
During puberty, the male sex hormone, testosterone helps boys develop male physical features like body and facial hair, deeper voices and muscle strength. Testosterone is also needed for men to make sperm.
When a man does not have enough testosterone in his body it is called hypogonadism, or low-T. Levels of the hormone normally decrease with age. About 4 out of 10 men over the age of 45 have low testosterone. It is seen in about 2 out of 10 men over 60, 3 out of 10 men over 70, and 3 out of 10 men over 80 years old. Men with certain health problems, including diabetes and obesity, also tend to also have low testosterone.
You may have low-T if you have the following:
• anemia (low iron)
• depressed mood or irritability
• fewer and weaker erections
• less energy
• less muscle mass and strength
• loss of calcium from bones
• low sex drive
• more body fat
If you think you may have low-T, it is important to see a doctor to make sure you have low-T and not another condition. Many of the symptoms for low-T can be the result of other health problems. For example, decreased energy and depressed mood may be caused by a variety of different health conditions and not of low-T. Diagnosis of low-T begins with a review of your medical history, a physical exam and blood work to measure your testosterone levels.
If the symptoms of low-T are bothering you, talk with your doctor about whether or not you are a candidate for Testosterone Replacement Therapy (TRT).
“TRT comes in many forms, including skin gel, shots, long-acting pellets placed under the skin or patches,” said Dr. Welliver. “The patient will work with his physician to figure out which option is best for him.”
About 70 percent of men treated for low-T use a skin gel. It is rubbed onto the shoulders or upper arms after a shower. Dr. Welliver noted that men with children should be especially careful when using the gel as they may come in contact with it by touching the site where it was applied, or they may touch leftover gel on unwashed clothes or towels. Pregnant women should also be very careful to avoid TRT gel.
TRT is a life-long treatment. If you stop taking it, your testosterone levels will drop. Some men with low-T decide not to be treated. They may find other ways to increase their energy level, or they may decide to live with the changes in their sexual desire and body.
Who Should Not Take TRT?
Dr. Welliver cautions men with an untreated heart problem, sleep apnea or a history of elevated red blood cell counts to not take TRT, as testosterone could worsen these conditions. Men with prostate or breast cancer should carefully use TRT for the same reason, he said. “Men planning on having children should avoid TRT, because it can decrease sperm count and fertility,” said Dr. Welliver.
Do not take TRT for non-medical reasons, such as body building, preventing aging changes or performance enhancement. Men who have normal testosterone levels will not be helped by TRT. “Some men buy testosterone-boosting products at the gym or online, and that can be dangerous,” warned Welliver. “You don’t know what’s in those products as they are not regulated by any governing body.”
The long-term use of TRT has not been extensively studied, Dr. Welliver noted. Several studies have suggested TRT raises the risk of a heart attack in men. There are also studies that suggest TRT may lower heart attack risk. One recent study of 44,000 men with low testosterone levels found men who used TRT had a 33% lower risk of heart attacks and stroke compared to those who did not receive any hormone therapy.
Studies have found no increase in prostate cancer risk among men who take testosterone compared to men who don’t, but Dr. Welliver notes the long-term effects of TRT on heart disease and prostate cancer need more research.
“While many men see positive effects from using TRT, like changes in energy and sex drive, there are still a lot of unknowns about it,” Dr. Welliver said. “That’s why it’s important to only use TRT under the direction of a knowledgeable physician who is familiar with testosterone treatment.”
TRT Side Effects
If you take TRT, your doctor will monitor you regularly with blood tests for testosterone levels, prostate issues and red blood cell count.
Side effects of TRT can include:
• breast swelling or soreness
• high red blood cell count
• swelling of the feet or ankles
• smaller testicles
• enlarged prostate
To find a urologist near you visit: UrologyHealth.org.
Living with Active Surveillance
A Patient’s Story
When Carl Snook, a now retired middle school principal, was diagnosed with early-stage prostate cancer four years ago, he talked his options over with Dr. O’Reilly. “When I first got a diagnosis of prostate cancer, it took over my life for awhile,” says Snook, now 68 years old. “I did research and found out most men with prostate cancer don’t die of the disease.”
He and Dr. O’Reilly discussed the treatment options, including active surveillance, surgery and radiation. “We talked about the possible side effects of prostate cancer treatment, such as incontinence and erectile dysfunction. I decided that active surveillance was a good choice for me,” Snook says. “Dr. O’Reilly assured me that if I changed my mind later on, we could change the treatment plan.”
In the first two years of active surveillance, Snook had several biopsies. In the past several years, he has had MRIs and blood tests to assess his prostate cancer. There has been no significant change.
Snook believes that having a good relationship with your doctor is key to the success of active surveillance. “I have a lot of trust in Dr. O’Reilly. I know that if there were big changes in my prostate cancer, he would give me my options, and we would makes changes in my treatment plan,” he says.
“I feel very comfortable with active surveillance,” Snook adds. “It allows you to live your life and in my case, enjoy my retirement. You’re monitoring your prostate cancer, but it’s not taking over your life. I think about it two to three times a year when I go in for an appointment, but I’m not overly concerned about it in between appointments.”