How Low Testosterone Affects Health, Mood, and Sex
Low Testosterone: How to Talk to Your Doctor
Asking about symptoms of low testosterone might seem embarrassing. Just talking about it might make you feel like you're light in the manhood department. But if you're wondering about low testosterone, you're far from alone.
Low testosterone becomes more common with age, affecting millions of men in the U.S. Although it may cause no symptoms, low testosterone can also result in poor libido, erectile dysfunction, depression, and loss of energy. These symptoms of low testosterone can masquerade as ordinary aging -- when, in fact, it's a treatable condition.
"Most men don't ask about it," says Karen Herbst, MD, an endocrinologist with the University of California at San Diego. "It would be great if they would." Talking with your doctor is the only way to find out if increasing testosterone levels would help reduce symptoms.
Testosterone levels naturally decline with age. Men lose about 1 percent per year of their testosterone levels after age 40. In middle age and later, levels can dip below the threshold of what's considered normal.
Population studies suggest that 10% to 25% of men over 50 may have low testosterone. When asked about symptoms, though, only about one-half to two-thirds ofthese men report any symptoms of testosterone deficiency.
And the symptoms are what matters, Herbst tells WebMD. Unless a man has symptoms, Herbst believes that he should not have a testosterone test.
Low Testosterone: Symptoms and Treatment
Low libido and erectile dysfunction are two common symptoms of low testosterone. But other symptoms are often vague and nonspecific. For example, fatigue, difficulty concentrating, depression, and irritability are common in men, and frequently occur with normal testosterone levels.
Low testosterone symptoms can also be insidious. Unlike menopause, when women's estrogen levels abruptly fall to very low levels, "andropause" in men is a slow, steady decline in testosterone over decades. Changes in muscle mass, libido, and mood can be subtle, even unnoticed by a man himself.
Herbst thinks physicians could do more to ask about the symptoms of low testosterone. She adds, "Most of the time, it's the last thing I ask about. ‘How's your libido? Are you having any symptoms of ED?'" If a man over 50 mentions problems, a testosterone test is the appropriate next step, Herbst says.
Testosterone replacement therapy can help reduce symptoms. But talking with your doctor about any problems you have can be a tough conversation to start. In one study, 82 percent of men with erectile dysfunction wished their primary doctor had asked them about symptoms earlier. The vast majority of these men said they felt too embarrassed to initiate the discussion about ED themselves.
Andre Araujo, PhD, an epidemiologist focused on testosterone deficiency and treatment patterns, found treatment rates to be surprisingly low in a recent study in Boston. "Only about 12 percent of men with [symptoms of low blood testosterone levels] were receiving testosterone," Araujo says. "We can't say they should have been treated, but the low treatment rate didn't seem due to poor access to care or unwillingness on their part."
Asking About Your Symptoms
There's no magic to asking your doctor about symptoms you're having that might be related to low testosterone, Herbst says. "I think you just say what you feel, and start the conversation that way."
Still, it's not always easy to have a good discussion about sensitive issues in a few minutes of face time with the doctor. You can jump-start the conversation if you organize your thoughts before your visit. Here are a few possible ways WebMD suggests to talk to your doctor about possible symptoms of low testosterone.
For men with problems with energy, concentration, and well-being: "I've been feeling out of sorts -- just not myself. I'm tired and sleepy all the time, and I can't seem to keep my mind on task. I get eight hours of sleep every night but I'm still tired. I'm wondering if something else going on. Do you think I need a testosterone test?"
For men with low libido or erectile dysfunction: "I know I'm not 18 anymore. But it seems like I should have more sex drive than I do. I don't feel interested in sex, and I've had no sex drive for months. I know it bothers my wife, too. When it does happen, there are some problems with having a firm erection. It's pretty embarrassing to talk about, but I want to make sure there's nothing medical causing this."
For men with symptoms of depression: "My family says I'm depressed. I admit that I'm irritable most of the time and can be hard to be around. I don't like that. I'm not lying in bed all day, but my energy is down and I don't feel interested in the things I used to. It's hard to concentrate. All this makes me feel like a bad husband and dad. Can low testosterone cause these symptoms?"
Long-term studies on the risks and benefits of testosterone replacement are years away from providing meaningful answers, Araujo says. Until then, the best approach to possible symptoms of low testosterone is to bring them up with your doctor.
Keep this in mind, too: if you don't have symptoms of low testosterone, it doesn't make any sense to order a testosterone test. Because of potential testosterone side effects, testosterone replacement isn't recommended just for a low level without symptoms since low levels may just be a normal part of aging.
Low Testosterone: Questions for Your Doctor
- Are my symptoms definitely from low testosterone, or could they be caused by some other problem?
- What are the possible benefits of testosterone supplements?
- What are the side effects of testosterone replacement therapy? What are the risks?
- How long would my treatment with testosterone replacement therapy be?
- What kind of lifestyle changes -- like exercise, or diet -- could I try before testosterone treatment?
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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