This decline can affect men in several ways, such as loss of energy, reduced sex drive, erectile dysfunction, loss of muscle mass, loss of strength, loss of bone mineral density, increase in body fat, decreased sense of well being, and several other undesirable affects that can dramatically decrease quality of life. Such changes, in association with low testosterone levels, have been called "male menopause."

With people living longer and a stronger emphasis today on quality of life many men are looking to testosterone replacement therapy (TRT) as a new fountain of youth.

Testosterone replacement therapy (TRT) in aging men is a widespread, growing practice. According to pharmaceutical industry estimates, more than a total of 2.3 million prescriptions were written for these products in 2005 and the numbers are growing.

In order to be treated correctly, and to even be properly considered for male hormone therapy several male hormone levels should be reviewed.

As far as a Testosterone Replacement therapy approach, measuring for the items above should give the doc a pretty good picture, especially if used in conjunction with a eval of testosterone/estrogen levels (ratio).  

Causes of Testosterone Deficiency

Testosterone deficiency results from the testes being unable to produce the normal levels of testosterone. This deficiency can be physiological or pathological. Physiological deficiency occurs with age. As a man ages, the amount of testosterone in his body gradually declines. This natural decline starts after the age of 30 and continues throughout the life.

Best Candidates for Testosterone Replacement Therapy

Men with the primary hypogonadism are best candidates for testosterone replacement therapy.  In this condition testosterone levels are low and pituitary gonadotropic hormones are elevated.  

Pros and Cons of Testosterone Replacement Therapy

There are many pros and cons of testosterone replacement therapy if your levels are low.

Pros Testosterone Replacement Therapy

Many of the pros can make you feel like a new person and increase your quality of life (e.g., improved energy, decreased lethargy, increased sex drive, better erections, increased muscle mass, lower body fat, improvement in your sense of well being, improvements in bone health).Here are some recent studies supporting the possible of benefits of testosterone replacement therapy (TRT):

• Lowers Risk of Death. Men may not live as long if they have low testosterone, regardless of their age, according to a new German study. The new study adds to the scientific evidence linking deficiency of this sex hormone with increased death from all causes over time--so-called "all-cause mortality."  Men with low testosterone levels had more than 2.5 times greater risk of dying during the next 10 years compared to men with higher testosterone, the study found. This difference was not explained by age, smoking, alcohol intake, level of physical activity, or increased waist circumference (a risk factor for diabetes and heart disease), according to the researchers. The results should serve as a warning for men with low testosterone to have a healthier lifestyle, including weight control, regular exercise and a healthy diet, said lead author Robin Haring, a PhD student from Ernst-Moritz-Arndt University of Greifswald, Institute for Community Medicine. Reference: The Endocrine Society (2008, June 21). Low Testosterone Appears To Increase Long-term Risk Of Death. ScienceDaily. Retrieved January 10, 2009, from http://www.sciencedaily.com­ /releases/2008/06/080617124020.htm 
  

• Reduces Risk for Health Problems That Lead To Erectile Dysfunction. According to a June 2008 published report low testosterone appears to be a common denominator for several health conditions that can increase the risk for erectile dysfunction. "Erectile dysfunction is a portal into men's health," said the study's senior author, Aksam Yassin, MD, PhD, of the Clinic for Urology and Andrology of the Segeberger Clinics in Norderstedt, Germany. "It is becoming clear that obesity, diabetes, high blood pressure, cholesterol problems and erectile difficulties are intertwined, and a common denominator is testosterone deficiency. Reference:The Endocrine Society (2008, June 20). Low Testosterone May Cause Health Problems That Lead To Erectile Dysfunction. ScienceDaily. Retrieved January 10, 2009, from http://www.sciencedaily.com­ /releases/2008/06/080616210025.htm
  

• Improves Cognitive Function. New research suggests that testosterone levels may affect men's cognitive performance. According to a study in the January 2008 issue of Harvard Men's Health Watch higher testosterone levels are associated with better performance on cognitive tests, while androgen deprivation therapy, which is sometimes used in treating prostate cancer has been shown to negatively affect cognitive performance. Reference: Harvard University (2008, January 14). Testosterone May Improve Mental Function. ScienceDaily. Retrieved January 10, 2009, from http://www.sciencedaily.com­ /releases/2008/01/080109111320.htm

• Improves Risk Factors for Cardiovascular Disease and Type 2 Diabetes.  In older men with low testosterone levels, testosterone replacement therapy improves their risk factors for cardiovascular disease and diabetes, according to two new studies. The first study showed that testosterone treatment significantly reduced waist circumference, total cholesterol, LDL ("bad") cholesterol, triglycerides, and body mass index (a measure of body fat). Treatment also increased "good" cholesterol. Improvements were progressive over 12 months, indicating that benefits may continue past a year. In the second study, the researchers found that the oldest men had similar improvements in metabolic risk factors to the youngest men.Reference: The Endocrine Society (2008, June 23). Testosterone Replacement Benefits Older Men With Low Testosterone, Studies Suggest. ScienceDaily. Retrieved January 10, 2009, from http://www.sciencedaily.com­ /releases/2008/06/080617124016.htm

• Benefits Bone Health. Approximately two million males have been diagnosed with osteoporosis and another three million are at risk. A recent study has shown that testosterone replacement therapy (TRT) can significantly improve bone mineral density (BMD; also known as bone mass). Reduced bone density or bone mass means there is less cushioning to protect the bone from cracking in a slip or fall. Testosterone replacement therapy (TRT) is now becoming the standard of care used to improve bone strength and muscle mass in males. A 2008 study conducted by the Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX found that testosterone administration appears to reduce bone turnover, perhaps closing the gap between resorption and formation. According to Dr. Dillon, the study's first author, "These preliminary data show beneficial effects of testosterone therapy on bone turnover markers in older men with low-to-normal testosterone concentrations using both continuous and monthly cycled testosterone replacement." He added, "The effects of sex hormones on markers of bone formation are complex, but this is an important step in understanding how the process works." Source: Continuous Testosterone Administration for Five Months Reduces Markers of Bone Turnover in Older Men.

• Reduces Risks for Bone Breaks, Falls. Low testosterone levels may be associated with a higher risk of falling in older men, according to a report in the October 23, 2006 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. According to the study men with lower bioavailable testosterone levels were significantly more likely to fall and to fall multiple times than those with higher levels--among the one-fourth of participants with the lowest testosterone levels, the risk for falling was 40 percent higher than among the one-fourth with the highest testosterone levels. Reference: JAMA and Archives Journals (2006, October 25). Elderly Men With Low Testosterone Levels More Likely To Fall. ScienceDaily. Retrieved January 9, 2009, from http://www.sciencedaily.com­ /releases/2006/10/061024010353.htm

• Reduces Risk for Depression. Men with lower free testosterone levels in their blood appear to have higher prevalence of depression, according to a new study. The mechanism by which low hormone levels might affect depression risk has not been identified, but might involve changes in the levels of neurotransmitters or hormones in the brain, according to the researchers. Journal reference: Arch Gen Psychiatry. 2008;65[3]:283-289.

Cons of Testosterone Replacement Therapy

The cons associated with the therapy, could include:

• Increase of blood cholesterol levels
• Increased red blood cell count (which could be a health improvement if you have anemia or low blood count). If your levels are normal however, your risk for heart attack or a stroke can increase.
• Changes in blood lipid concentration. Physiologic testosterone replacement is known to reduce total cholesterol, low density lipoprotein (LDL), and high density lipoprotein (HDL) levels.  These elevations can cause significant increase in blood viscosity and can increase risk for heart disease and stroke.
• Increase in skin conditions/break outs.
• Increase in body hair, acceleration of head hair loss
• Fluid retention (can be a significant health risk for those with a history of heart failure or kidney disease).
• Decrease in sperm count producing infertility, etc.)
• Gynocamestia (breast enlargement)

Dispelling Myths of Testosterone Replacement Therapy

Testosterone Replacement and Prostate Health

Several studies over the past 3 years suggests that testosterone replacement therapy for men with low testosterone levels appears to have little effect on the prostate gland, contrary to some reports that this therapy may be harmful. Thanks to this recent research this means that between 2 and 4 million men that were previously considered "risky candidates" for testosterone replacement therapy (TRT) may be good candidates for treatment. Note: men with advanced prostate cancer, may not be good candidates for TRT since testosterone administration often worsens the disease. Additionally, even in men with no sign of prostate cancer, the possibility of stimulating growth in subclinical disease exists, therefore when TRT is prescribed, careful monitoring for prostate disease is still considered prudent. Reference: The Endocrine Society (2008, June 23). Testosterone Replacement Benefits Older Men With Low Testosterone, Studies Suggest. ScienceDaily. Retrieved January 10, 2009, from http://www.sciencedaily.com­ /releases/2008/06/080617124016.htm 

Methods of Testosterone Replacement Therapy

In regards to methods of Testosterone Replacement therapy, the healthiest would be injections. By injecting hormone directly into the muscle it is the most effective therapy, however some people do not like needles or the inconvenience.

For the needle averse there are patches and gels. If patches are used it is best when these patches are applied to the skin on testicles, but, they can be applied almost anywhere on the body.  The non-scrotal patch, known as Androderm, is meant to be worn on the arm or torso. In regards to the gel, the most common is called Androgel. Androgel is applied to the skin once a day.  The main disadvantage of Androgel is the price.

The benefits of male hormone therapy are typically seen in as little as 3 weeks with injections, and up to 6 weeks when using gels and patches.

Testosterone Replacement Therapy Bottom Line

Get your blood panel done and have it evaluated by a knowledgeable endocrinologist.  Between you both you can way the benefits and risks associated with testosterone replacement therapy. Note: It is important that the endocrinologist has the appropriate information on your overall health and your medical history in regards to chronic disease, heart health, and full blood chemistry panel since the endocronologist will need to understand all potential risks your history and background may bring to the potential hormone treatment plan.

About the Author, Jeff Behar

Jeff Behar, MS, MBA

Jeff Behar, MS, MBA is a recognized health, fitness and nutrition expert, regularly writing about hot topics in the areas of health, fitness, disease prevention, weight loss, nutrition, anti aging and alternative medicine. Jeff Behar's work also often appears in several of the major health and fitness newsletters, health and fitness magazines, and on major health, fitness and  weight loss websites. Jeff Behar is also the CEO of MuscleMagFitness.com, and MyBestHealthPortal.com; two very popular health, fitness,