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Sunday, July 22, 2018

Understanding Low T

DoctorAsk The Doc

Question:  I keep seeing ads about  “Low T” or “ low testosterone” and as a middle aged male I am wondering if it is something I should be concerned about?

Answer: Testosterone is a hormone that is found in both men and women.  It plays a role in many human traits such as sex drive, exercise endurance, mood and mental acuity.  In men it is produced principally in the adrenal glands and the testes. In women it is produced mainly in the adrenal glands and the ovaries.  Normal lab values of testosterone in men are roughly 10 times the normal values in women.  Testosterone Replacement Therapy (TRT) has been used for many years to treat hypogonadism in males and improve sex drives in both men and women.  It also has been used illicitly for many years by body builders and professional athletes in an effort to improve performance and appearance.

Because of the illicit use that testosterone therapy sometimes has a stigma attached to it. Like most drugs it can be a two-edged sword.  If you need it and use it appropriately, testosterone can really improve your life.  If you don’t, it can really complicate your life and ruin your health.  Used under a doctor’s guidance it can be a safe and effective way to treat a common problem faced by many middle aged and older men.

Andropause, which is the male equivalent of menopause, is the result of a natural reduction of testosterone as we get older.  A 70-year-old man has a fraction of the testosterone that he did when he was 20. This is not always a big problem, but sometimes it is and then it should be corrected.  Low testosterone, or Low T, has received more attention lately as doctors have increasingly recognized that it is common and can usually be easily treated.  Another reason we are hearing more about Low T is because the pharmaceutical companies have recently produced new topical delivery systems.

Axiron, for example, can be applied under your arms and there are other topical or oral systems that you can use at home.  There are downsides with the topical systems; they can be expensive, you have to remember to use it every day, and you can inadvertently expose children and the woman in your life to higher levels of testosterone than is healthy for them.

Axiron runs $500 or more per month.  If you have a good health insurance policy maybe it will cover it but there are less expensive methods that have been around for years.  You can get oral lozenges that are dissolved in your mouth daily for around $150 to $200 a month.  You can get pellets surgically placed under your skin which will last up to 6 months for about $600 to $800. Or, you can get testosterone shots from your doctor for around $50 to $75 a month.  Beside cost comparisons, each delivery system has relative positives and negatives that you should discuss with your doctor.

All of these approaches require that you first do some blood work to look for low testosterone levels in your blood and a physical exam to make sure you are an appropriate candidate for Testosterone Replacement Therapy.

So, how do you know if TRT might be a good idea?  Answer the following questions:

1. Do you have a decrease in libido/sex drive?

2. Do you have less energy than you used to?

3. Do you have a decrease in strength and/or endurance?

4. Have you lost height?

5. Have you noticed a decreased enjoyment of life?

6. Are you sad, grumpy, and/or easy to anger? (If unsure, ask your wife and children)

7. Are your erections less strong?

8. Have you noticed a recent deterioration in your ability to exercise or play sports?

9. Are you falling asleep after dinner?

10. Has there been a recent deterioration in your work performance and/or your ability to concentrate?

If your answer is yes to questions 1 or 7, or yes to any combination of 3 questions you should be evaluated for low testosterone.

To those that need it, benefits of testosterone supplementation should be significant.  You should have improved energy, your attitude about life and your mood should generally improve.  Your ability to exercise, lose weight and concentrate should improve.  Your interest in sex and ability to perform should improve. Your blood pressure should lower, as should your blood sugar and cholesterol.

As with most medical therapies, it can cut both ways.  Just because a little is good, more is not better.  It is important to find that therapeutic sweet spot.  Men who have Low T will usually see dramatic benefits from supplementation, but if you have normal lab values and start supplementing testosterone, or take too much testosterone, all sorts of bad things can happen.  Signs and symptoms of testosterone overdose include fits of rage and anger (known as Roid Rage), testicular atrophy, systemic acne, high blood pressure, kidney disease and cardiovascular disease.

You can find testosterone on the street illegally, but for the reasons noted in the last paragraph, I highly recommend against it.  If you think you have Low T and are properly evaluated for it, you can safely use testosterone to improve your life.  But without the blood work and the doctor’s oversight, you would really be playing with fire.

In conclusion, there may not be an actual fountain of youth, but for many middle aged and older males, with documented blood levels of low testosterone, Testosterone Replacement Therapy, coupled with healthful life style choices might be as close as you can get.

If you have a question you would like to submit to Ask The Doc please send it to info@laveencountrydoc.com

Dr. Runbeck can be reached at 602.237.9910 or info@laveencountrydoc.com




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