Using testosterone in men

There’s a long-brewing controversy about using testosterone in older men. The interest in testosterone replacement is being fueled by several popular books and consumer ads about what is now called “low T.” But, according to the doctors of pharmacology who write the Prescriber’s Letter (a publication I recommend highly to prescribers), experts disagree whether testosterone replacement is a fountain of youth … or a misguided attempt to treat normal aging.

The experts at Prescriber’s Letter have concluded that testosterone replacement MIGHT help improve energy, strength, bone density, and sexual function. But, unfortunately, there’s no proof that it’s safe for older men. Why? Well, at least one concern is that testosterone may increase the risk of prostate cancer … similar to estrogen and breast cancer.

As a result, I think physicians should save testosterone for men with documented low levels of testosterone PLUS significant symptoms, such as reduced sexual function, libido, or strength.

And, for these men, I chose a product based on patient preference … with most of my patients choosing transdermal products (such as patches, gels, or buccal products) … instead of injections. I usually start with Androderm patches 5 mg/day … AndroGel or Testim gel 5 g/day … or Striant buccal system 30 mg BID. However, these are very expensive products.

Prescriber’s Letter recommends that men avoid oral methyltestosterone … due to possible liver toxicity. And, Prescriber’s Letter recommends the therapy should be discontinued if there’s no improvement in 3 to 6 months.

The experts also recommend that while men are on testosterone treatment, that their testosterone levels, hematocrit, and prostate be checked at 3 to 6 months  of treatment … then at least yearly. Also, have your doctor check your lipids and liver function tests periodically.

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