Testosterone tends to ebb and flow in men. More in the morning, less in the evening. More in youth, less as maturity deepens.
The ebbs tend to increase as men age, with a 1 percent to 2 percent reduction in testosterone production each year after the age of 40.
As with the body's production of anything, there can be glitches. Injections, pellets, patches, gels, or pills of testosterone may help.
“The bulk of the men are coming in for fatigue and decreased libido,” said Dr. Thomas Zaciewski, a urologist with Mercy Health working in the Tiffin area.
They also may be seeing decreased muscle mass with no gains being made from workouts at a gym. There is erectile dysfunction. There may be difficulty concentrating or staying on task. Men with diabetes or who are overweight also may have low testosterone, according to Dr. Zaciewski.
Use of supplemental testosterone has been increasing among both men and women.
The issue of low testosterone, or “low T,” for aging men has been a growing topic in today's society. A study published in JAMA Internal Medicine showed prescriptions for testosterone therapy tripled between 2001 and 2011 for men older than 40. Then, from 2013 to 2023, prescriptions for testosterone increased by another 50 percent, according to data released by the health technology company IQVIA.
Increased use of the hormone is being driven, in part, by women in their 40s and 50s.
“Both sexes have detectable levels of testosterone,” said Dr. Tim Schuster, a urologist affiliated with ProMedica.
In the past, there have been concerns that testosterone therapy may cause major cardiac events, but recent studies have largely alleviated that issue.
“The TRAVERSE Study is the largest trial of testosterone replacement therapy in men with hypogonadism,” said Dr. Shalender Bhasin, a co-principal investigator of the TRAVERSE Study at Brigham and Women's Hospital in Boston. “These findings do not justify testosterone treatment of men who do not have hypogonadism, and they should not [assume] that large doses misused by athletes and bodybuilders are safe.”
Men with low testosterone, known as hypogonadism, should not attempt to treat it without the help of a medical professional.
“The market is booming with so-called ‘natural’ testosterone boosters, and men need to be careful,” said Dr. Steven Nissen, chief academic officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic and a senior author of the TRAVERSE Study, which included 5,246 men ranging in age from 45 to 80 years of age who had pre-existing or a high risk of cardiovascular disease and who reported symptoms of hypogonadism.
And too much testosterone can result in aggressive behavior.
Treatment of low T is not as straightforward as it may seem, especially if a man is interested in having a family.
There are two areas that are important to testosterone production in a man — the pituitary gland and the testicles. Some testosterone is released in the blood, and the testicles will increase or decrease their own production of the hormone to maintain a consistent balance. Adding more testosterone into the bloodstream will cause the testicles to lower production of testosterone and decrease fertility.
Other side effects can include a thickening of the blood, and an increase in the size of the prostate, according to Dr. Schuster, who points out that what is considered the normal amount of testosterone is still being debated.
For women, the balance of testosterone in the body is even more delicate, he said.
While testosterone can help build bone density, there can be unwanted side effects such as the growth of facial hair.
However, use of testosterone by women is trending. The FDA has not officially approved testosterone for use by women, but it has become an off-label use for menopausal and post-menopausal symptoms.
First Published December 22, 2024, 5:00 a.m.
