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Dr. Jason Clemons

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A normal part of aging in men is testosterone deficiency. It is estimated that as many as 1 in 5 men age 60 and older suffers from low testosterone[1], as testosterone levels normally decrease with age. But for men wanting to lead a healthy, active lifestyle, decreased testosterone can negatively impact quality of life.

Testosterone is the hormone responsible for maintaining sex drive, sperm production, pubic and body hair, muscle, and bone mass. Men suffering from low testosterone, also known as hypogonadism, can experience erectile dysfunction, fatigue, increased body fat, decreased bone mass and mood swings[2]. Low testosterone is also associated with a number of co-morbidities, such as obesity, Type 2 diabetes, hypertension, osteoporosis and metabolic syndrome[3], thus long-term health risks are of concern for patients with this condition.

 If you are suffering any of these symptoms or suspect a decline in testosterone, you should schedule an appointment with your doctor. Your physician can diagnose low testosterone with a physical exam, medical history review and blood tests.

 A medical history can reveal if a man has a current or recent illness, any genetic diseases in the family, taken certain medications or experienced any stressful events that could impact hormone levels. A blood test will determine if testosterone levels are within the normal range of 300 to 950 nanograms per deciliter (ng/dl)[4]. This “normal” range is large and accounts for all age ranges. Currently, there are no age-specific ranges that have been set or accepted by consensus in the medical community. As one would expect, in general, the higher values will represent younger individuals and the lower values in the range will likely be found in older individuals or those with hypogonadism. The number value serves as only one portion of the evaluation of low testosterone. Therapy should be tailored to each individual.

 In the past physicians would typically treat low testosterone with hormone replacement therapy. However, recent studies have shown conflicting evidence as to whether replacement therapy is effective. Although some research shows treatment can help increase sexual interest and restore muscle mass or improve bone density[5], other studies have shown inconsistent results for sexual function and energy[6]. Some evidence questions whether replacement therapy could even potentially cause harm, as reflected in the 2015 FDA warning that supplementing testosterone could increase cardiac risks, including plaque buildup[7].

 If you and your physician decide to pursue replacement therapy, testosterone can be replaced with prescription pills, injections, patches, gels, gum, nasal spray or implanted pellets. The method selected will depend on several factors, including the cause of the problem, patient preference, ability to tolerate medications and cost.

 All men taking hormone replacement therapy are at risk for breast enlargement and should be closely monitored for signs of prostate cancer and cardiac side effects. They should report any problems with breathing, especially while sleeping, to their physicians. For more information about low testosterone, talk with your doctor or call 877.909.4233 for a free referral to an endocrinologist near you.

Dr. Jason Clemons is a primary care physician at Brookwood Baptist Health, Primary and Specialty Care Talladega.

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