Written By Caitlin Schille

Aging often comes with changing health difficulties and struggles. For men, one of these difficulties is a lowering of blood testosterone levels as they get older. In fact, blood testosterone levels can decline so significantly with aging that the level will reflect a “low” level as determined by a laboratory test.

These “low” levels, combined with symptoms including feeling lethargic, out of shape, and having decreased sexual performance, cause many men to seek treatment. Often, the simplest treatment that men turn to is testosterone supplementation.

Prescriptions for testosterone supplementation have more than doubled in the last eight years, and soon they will be a $5 billion per year market, market research suggests. Clearly, this is a popular fix.

According to the Mayo Clinic, testosterone therapy can help treat hypogonadism, a condition describing the state when the body isn’t producing enough testosterone by itself.  But here a complication arises, because many men without a clinical diagnosis of hypogonadism take testosterone supplements in hopes to simply decrease some unsavory symptoms of aging and worsening sex life. When testosterone levels are checked, what one doctor considers low might not be low for another medical professional. Currently, there is not a firm consensus on what constitutes low testosterone and what number should result in testosterone replacement therapy. Further complicating the issues of correct diagnosis is the fact that testosterone levels fluctuate throughout the day.

For healthy men, testosterone supplementation may not be effective. The Mayo Clinic cautions that in “otherwise healthy men,” there is no scientific evidence to suggest that prescribing testosterone to men over the age of 65 with normal or low-to-normal testosterone levels is effective.

In fact, not only could testosterone supplementation be ineffective for that cohort of people, it could actually pose some health risks. A study published in the New England Journal of Medicine found that compared to men who did not take testosterone supplements, the men who did had higher rates of adverse cardiac events such as heart attacks as well as higher rates of respiratory illness such as chronic obstructive pulmonary disease (COPD). While the connection between testosterone supplementation and prostate cancer has not yet been studied in humans, preliminary studies with rats have found that it was a “strong tumor promoter for the rat prostate.” These potential implications are so serious that the FDA has even issued a warning against the rampant over-prescription of drugs meant to dramatically boost testosterone levels.

But research does confirm that testosterone supplements do have benefits for certain people. Another study published this year online in The New England Journal of Medicine found that for men over the age of 65 with a serum testosterone concentration of less than 275 ng per deciliter (moderately low, according to the researchers), raising these levels resulted in moderate benefit with respect to sexual function.

Discernable symptoms and a medical diagnosis is probably the best indicator that testosterone supplements are an acceptable option. Even then, patients should make an informed decision that isn’t influenced by the loud “low-t” voices that fill media airwaves and screens.

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Caitlin Schille
Caitlin Schille, MPH, is a writer and health expert for Healthy Magazine. She graduated from Brigham Young University with a B.S. in Public Health & Epidemiology and has a Master of Public Health degree from the University of Michigan. She is now a public health researcher at the University of North Carolina at Chapel Hill.
Caitlin Schille

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