Low Testosterone in Men (Male Menopause)

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Dr. Laurence Belkoff is a Urologic Consultants physician at Hahnemann University Hospital

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Decreasing levels of testosterone are a natural part of aging. In general, testosterone level gradually declines about 1 percent a year after age 30; by age 70, the decrease in a man's testosterone level can be as much as 50 percent. Low testosterone, also known as hypogonadism, also can be caused by a problem with the testicles or the pituitary gland.

Signs of low testosterone include

  • Sexual changes, including erectile dysfunction, reduced desire and infertility
  • Low energy and fatigue
  • Increased body fat and obesity
  • Reduced muscle mass
  • Reduced bone density
  • Insomnia or other changes in sleep patterns
  • Depression, sadness, trouble concentrating, memory loss, lack of motivation and other emotional changes

    These symptoms can be caused by other factors as well, including medications, thyroid problems, depression and alcohol or drug use.

    Low testosterone often occurs in obese men and men with high blood pressure and/or cholesterol, diabetes and HIV/AIDS. It is diagnosed with a blood test taken in the morning, the most accurate time to measure testosterone levels.

What is testosterone replacement therapy?

Testosterone replacement therapy can improve symptoms of low testosterone, improving energy level, sex drive, erections, sleep, mood and muscle mass. It may help with weight loss and sharpen memory and focus. It is most often used in the form of a gel, although it is also available as injections, patches or pellets.


Who can benefit?

Men who have low testosterone levels due to a medical condition can experience improved health and quality of life with hormone replacement therapy. It has been approved by the FDA in these instances. Hormone replacement therapy for age-related low testosterone warrants an honest discussion with your doctor and careful consideration of the pros and cons. Testosterone therapy for healthy men is not recommended.

What are the risks?

Testosterone replacement therapy is not a magical anti-aging formula for men. It may increase the risk of heart attack or stroke in men with heart disease, and may contribute to sleep apnea. It should not be taken by men with breast cancer or known or suspected prostate cancer, and it may contribute to symptoms of benign prostatic hyperplasia (BPH). It may cause testicle shrinkage and decrease fertility.


How do you know if it's right for you?

If you are experiencing symptoms or low testosterone, talk to your doctor. Anyone considering testosterone replacement therapy needs a thorough and careful evaluation by a primary care physician and/or urologist. It should include a detailed medical history, tests to determine the cause of symptoms and physical examination of the testes. Blood tests will be included to accurately measure testosterone levels, PSA levels (to check for prostate cancer) and red blood cell count (to check for heart disease).


What happens if hormone replacement therapy is recommended?

If you and your doctor decide to try testosterone replacement therapy, it is important that you take your medication as directed and keep all follow-up appointments. Your doctor will monitor you carefully while you are taking testosterone. As with other chronic conditions, hormone replacement for low testosterone is considered lifelong therapy, and your testosterone level will decline once you stop treatment.