A 65-year-old man notices he's feeling more tired lately. He's gaining weight and losing muscle. He can't get as many erections, and generally feels foggy and unwell.
His family doctor takes some blood tests and rules out thyroid problems, high cholesterol and blood sugar issues, among other conditions. The only finding is low testosterone -- but that's a normal part of aging, right?
While declining testosterone may be a normal part of aging, it should still be treated in men with symptoms. To me, that would be like saying cancer or vision loss are normal parts of aging and therefore they should not be treated.
As a urologist with an interest in men's health issues, I think we need to take "manopause" -- more properly know as Testosterone Deficiency Syndrome (TDS) -- much more seriously.
We don't do that with arthritic joints. We don't do that with malignant tumors. And we shouldn't do that with symptomatic low testosterone.
Every woman knows about the often dramatic effects of menopause -- the loss of menstruation, the hot flashes and mood swings. But few men realize that a similar, albeit more subtle, adjustment occurs in their lives at roughly the same age. That's a shame, because the symptoms of TDS worsen with time. I've seen it ruin men's quality of life just when they should be starting to enjoy retirement.
Fortunately it's easy to diagnose and treat low testosterone. Normally doctors take two blood tests on separate days, each between 6 a.m. and 10 a.m. If testosterone is low at a time of day when it should be high, the problem is more clear.
Medical providers use those results, along with a personal history (including your age and symptoms) to diagnose TDS. But first we rule out another cause like depression, poor sleep or other types of hormonal problems.
We treat low testosterone by building your levels of this hormone back up to normal pre-TDS levels.
Some men choose to come in every few weeks to their doctors' office to get an injection of liquid testosterone. There are however, newer preparations of testosterone that come in gels, roll-ons or patches.
I almost always prescribe these because you get a little testosterone every day, which more closely mimics our bodies' natural hormone release than getting it all at once. I avoid testosterone pills -- you have to take them three times a day with fatty meals. It's inconvenient, could prompt weight gain and may not be absorbed right.
It takes a few months to start feeling better, but by six months your brain fog should have lifted and you should be noticing more energy and greater libido. Some men with metabolic syndrome even find that raising their testosterone levels improves this pre-diabetic condition.
And men with diabetes who have low testosterone may find that more testosterone helps them manage their disease because it restores the energy they need to exercise and eat better. While there has been controversy surrounding the effect of testosterone on heart health, current evidence does not show increased cardiac risk to men taking testosterone replacement therapy.
Remember, when we replace testosterone, we are bringing men back up to normal ranges, essentially evening the playing field with other men without TDS.
Once you're on testosterone, expect to stay on it the rest of your life. Your family doctor will monitor you for any side effects, including irritation to the skin where the gel is applied, nausea or headaches.
Generally the medication is well tolerated. You should also be checked regularly for a rare, but serious thickening of the blood.
I think testosterone has suffered a bad rap because it has been abused by athletes, who take dangerously large doses for a muscle-building steroid effect. Not to mention the gym buffs who buy testosterone -- of uncertain quality -- off the Internet and take unhealthy, unnatural amounts without any medical monitoring. In truth, any drug is dangerous if abused in this way.
Don't let those stories scare you away from a medication that can help you feel your best as you age. I don't think men should have to accept changes to their health as they age as "normal" without being offered treatments that will improve the quality and quantity of their lives.
We don't do that with arthritic joints. We don't do that with malignant tumors. And we shouldn't do that with symptomatic low testosterone.
What about testosterone and prostate cancer?
Decades ago, doctors didn't give testosterone replacement medications because we worried these could increase your risk of prostate cancer. It was thought that testosterone could be the gasoline that fuels this cancer, which is so common in aging men.
But that concern has been debunked. Today, we don't routinely suppress men's testosterone when they have prostate cancer, unless that cancer has already spread. Sometimes, we even allow men with slow-growing tumors to supplement with testosterone if they have TDS.
Some studies have even shown that men with low testosterone may be at higher risk of developing prostate cancer compared to men with normal hormone levels.
It may be that raising testosterone unmasks a prostate cancer that was already there or causes a slow-growing one to move more quickly, allowing doctors to catch it on blood tests. For this reason, anyone on testosterone replacement therapy should receive a yearly PSA blood test looking for changes which may indicate the presence of prostate cancer.
You could also explore ways to raise your testosterone naturally through better diet, sleep and exercise. This will benefit your health and longevity in countless other ways.
Dr. Elterman is an Assistant Professor in the University of Toronto's Division of Urology, and is a staff urologist and Medical Director of the Prostate Cancer Rehabilitation Clinic at the University Health Network in Toronto. He has been a paid consultant and speaker for Eli Lilly and Mylan, two pharmaceutical companies that produce testosterone supplements.
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