How Low Testosterone Affects Health, Mood, and Sex
Low Testosterone: How Do You Know When Levels Are Too Low?
In recent years, Spyros Mezitis, MD, PhD, has found himself talking to a lot more male patients about low testosterone, a diagnosis he says is becoming increasingly common.
"More men are getting older, and men are more open about talking about erectile dysfunction," Mezitis, an endocrinologist at Lenox Hill Hospital in New York City, tells WebMD.
On the one hand, increased diagnosis of low testosterone is driven by an aging population, less stigma, and more precise tests. But there's another big reason why men come to Mezitis' office for a testosterone test.
"Men are bombarded by media, by advertising campaigns -- 'Don't feel well? Ask your doctor about low testosterone,'" he says.
They come in saying they feel excessively fatigued, weaker, depressed, and that they have lost their sex drive -- all common symptoms of a drop in testosterone.
"As an endocrinologist, I'm thinking hormones," says Mezitis, who estimates that about a quarter to a third of the men he tests for low testosterone have levels below normal. "Sometimes it is testosterone, sometimes it is the thyroid, and sometimes it's something unrelated to hormones."
What Is Testosterone and Why Does It Decline?
Testosterone is a hormone. It's what puts hair on a man's chest. It's the force behind his sex drive.
During puberty, testosterone helps build a man's muscles, deepens his voice, and boosts the size of his penis and testes. In adulthood, it keeps a man's muscles and bones strong and maintains his interest in sex. In short, it's what makes a man a man (at least physically).
After age 30, most men begin to experience a gradual decline in testosterone. A decrease in sex drive sometimes accompanies the drop in testosterone, leading many men to mistakenly believe that their loss of interest in sex is simply due to getting older.
"Some say it's just a part of aging, but that's a misconception," says Jason Hedges, MD, PhD, a urologist at Oregon Health and Science University in Portland. A gradual decline in testosterone can't explain a near-total lack of interest in sex, for example. And for Hedges' patients who are in their 20s, 30s, and early 40s and having erectile problems, other health problems may be a bigger issue than aging.
"A lot of the symptoms are mirrored by other medical problems," Hedges says. "And for a long time, we were not attributing them to low testosterone, but to diabetes, depression, high blood pressure, and coronary artery disease. But awareness and appreciation of low testosterone has risen. We recognize now that low testosterone may be at the root of problems."
Doctors will want to rule out any such possible explanations for symptoms before blaming them on low testosterone. They will also want to order a specific blood test to determine a man's testosterone level.
"The blood test is really the thing," Mezitis says.
Low Testosterone: How Low Is Too Low?
The bottom of a man's normal total testosterone range is about 300 nanograms per deciliter (ng/dL). The upper limits are 1,000 to 1,200 ng/dL. A lower-than-normal score on a blood test can be caused by a number of conditions, including:
- Injury to the testicles
- Testicular cancer or treatment for testicular cancer
- Hormonal disorders
- Chronic liver or kidney disease
- Type 2 diabetes
Some medicines and genetic conditions can also lower a man's testosterone score. Aging does contribute to low scores. In some cases, the cause is unknown.
A low score does not always translate to symptoms, Mezitis says, "but we often find something that's off when we see scores of 200 or 100 ng/dL."
Hedges agrees and warns that even if a man does not have symptoms, he may be well advised to seek treatment. Low testosterone scores often lead to drops in bone density, meaning that bones become more fragile and increasingly prone to breaks.
"That's something I would want to have a conversation about," Hedges says. "Bone density issues are not always apparent."
Low Testosterone Treatment
Having a gradual decline in your testosterone level as you age is to be expected. Treatment is sometimes considered if you're experiencing symptoms related to low testosterone.
If a young man's low testosterone is a problem for a couple trying to get pregnant, Mezitis and Hedges say testosterone injections are the best option. Given every few weeks, the injections stimulate sperm production and motility ("swimming ability"). When fertility is not an issue, the ideal testosterone delivery method is a daily gel or patch. Because they are applied on a regular and frequent basis, these treatments keep a man's testosterone at a steady level and keep his symptoms at bay. If you are using testosterone gel on your skin, be careful not to expose other people to the gel.
Hedges also describes implantable testosterone pellets, a relatively new form of treatment in which several pellets are placed under the skin of the buttocks, where they release testosterone over the course of about three to four months.
What Are the Risks and Benefits of Testosterone Treatment?
"If their symptoms are truly due to low testosterone, patients tell me that within a few weeks they notice a significant difference, though sometimes it is not too dramatic," Hedges says. "Sex is better, depression is better -- you can see it directly and quickly."
There are also risks. Testosterone treatment can raise a man's red blood cell count as well as enlarge his breasts. It can also accelerate prostate growth. Men with breast cancer should not receive testosterone treatment.
Testosterone treatment usually is not advised for men with prostate cancer. Hedges says some of the associations between testosterone replacement therapy and prostate health are currently being challenged. In his practice, he does offer testosterone treatment to men who have been treated for prostate cancer.
"The take-home [message] is treatment is safe as long as you get careful monitoring," Hedges says. "If there are known issues, patients should be treated by a specialist."
AXIRON is a prescription drug used to treat adult males who have low or no testosterone. AXIRON is not intended for use in women or anyone under 18 years of age. It is not known if AXIRON is safe and effective in children younger than 18 years old. Improper use of AXIRON may affect bone growth in children.
Important Safety Information for AXIRON
What is the most important information I should know about AXIRON?
AXIRON can transfer from your body to others. This can happen if other people come into contact with the area where the AXIRON was applied. Signs of puberty that are not expected (for example, pubic hair) have happened in young children who were accidentally exposed to testosterone through skin to skin contact with men using topical testosterone products like AXIRON. Women and children should avoid contact with the unwashed or unclothed area where AXIRON has been applied. If a woman or child makes contact with the application area, the contact area on the woman or child should be washed well with soap and water right away.
To lower the risk of transfer of AXIRON from your body to others, follow these important instructions:
- Apply AXIRON only to your armpits.
- Wash your hands right away with soap and water after applying AXIRON.
- After the solution has dried, cover the application area with clothing. Keep area covered until you have washed the application area well or have showered.
- If you expect another person to have direct skin-to-skin contact with your armpits, first wash the application area well with soap and water.
Stop using AXIRON and call your healthcare provider right away if you see any signs and symptoms in a child or a woman that may have occurred through accidental exposure to AXIRON. Signs and symptoms in children may include enlarged penis or clitoris; early development of pubic hair; increased erections or sex drive; aggressive behavior. Signs and symptoms in women may include changes in body hair and a large increase in acne.
Who should not use AXIRON?
Do not use AXIRON if you:
- have or might have prostate cancer
- have breast cancer
- are pregnant or may become pregnant or are breast-feeding. AXIRON may harm your unborn or breast-feeding baby.
Women who are pregnant or who may become pregnant should avoid contact with the area of skin where AXIRON has been applied.
What should I tell my healthcare provider before using AXIRON?
Before you use AXIRON, tell your healthcare provider if you have:
- breast cancer
- or might have prostate cancer
- urinary problems due to an enlarged prostate
- heart problems
- kidney or liver problems
- problems breathing while you sleep (sleep apnea)
- any other medical conditions
Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Using AXIRON with other medicines can affect each other. Especially, tell your healthcare provider if you take:
- medicines that decrease blood clotting
What are the possible side effects of AXIRON?
AXIRON can cause serious side effects. Call your healthcare provider right away if you have any of the following:
- If you already have enlargement of your prostate gland, your signs and symptoms can get worse while using AXIRON. This can include: increased urination at night, trouble starting your urine stream, having to pass urine many times during the day, having an urge that you have to go to the bathroom right away, having a urine accident, being unable to pass urine or weak urine flow.
- Possible increased risk of prostate cancer. Your healthcare provider should check for prostate cancer or any other prostate problems before you start and while you use AXIRON.
- In large doses AXIRON may lower your sperm count.
- Swelling of your ankles, feet, or body.
- Enlarged or painful breasts.
- Problems breathing while you sleep (sleep apnea).
- Blood clots in the legs. This can include pain, swelling or redness of your legs.
The most common adverse events include: skin redness or irritation where AXIRON is applied, increased red blood cell count, headache, diarrhea, vomiting, and increase in blood level of Prostate Specific Antigen (a test used to screen for prostate cancer). Other side effects include more erections than are normal for you or erections that last a long time.
AXIRON is flammable until dry. Let AXIRON dry before smoking or going near an open flame.
Axiron is available by prescription only
AXIRON is a controlled substance (CIII) because it contains testosterone that can be a target for people who abuse prescription medicines. Keep your AXIRON in a safe place to protect it. Never give AXIRON to anyone else, even if they have the same symptoms you have. Selling or giving away this medicine may harm others and it is against the law.
You are encouraged to report negative side effects of Prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
TS Axiron CON ISI, 10AUG2011 PV8160
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