Men with sexual dysfunction often question whether they should have their
testosterone level checked. Since there are a vast number of causes for
this complaint, including advanced age, obesity, sedentary lifestyle,
cigarette smoking, medications, heart disease, diabetes, anxiety, depression,
and recreational drug use, it is very important to first assess whether
the symptoms are consistent with testosterone deficiency. These include
low sexual drive, decreased morning erections, loss of body hair, enlargement
of breast tissue, and shrinkage of testicular tissue. Your doctor may
also find you have low bone density, another common sign.
What causes low testosterone? Most commonly this is an age-related phenomenon.
Testosterone levels decline with age at a rate of 1-2% per year, so deficiency
most commonly manifests after age 50. There can also be an underlying
problem with the glands in the brain that stimulate testosterone production
(pituitary gland, hypothalamus), though this is less common.
Testosterone therapy can improve low libido and erectile dysfunction in
men who have confirmed testosterone deficiency, based on symptoms and
lab results. However, if testosterone levels are normal, studies have
not shown that testosterone therapy provides any of these benefits.
There are many different formulations of testosterone replacement, the
most popular being gels. There is a risk of skin transfer of the medication,
leading to secondary exposure to it. It is therefore important to remember
the following precautions when using gels: wash hands thoroughly after
application, avoid skin contact with others till gel has dried, avoid
getting the site wet for approximately 5 hours after application, and
keep the application site covered with clothing. Other modalities of testosterone
therapy include patch (short-acting, applied daily), and injection and
Unfortunately testosterone therapy does pose some health risks, and anyone
who is considering therapy should be aware of these. Most recently, the
FDA issued a warning regarding the increased risk of blood clots. The
FDA is also currently investigating the cardiovascular safety of testosterone
use. Other known adverse effects include local reactions at the site of
application, increased red blood cell count (which itself increases the
risk of blood clots, stroke, and heart attack), acne, sleep apnea, fluid
retention, and infertility.
Heidelbaugh, Joel. Management of Erectile Dysfunction. Am Fam Physician.
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Margo, Katherine and Winn, Robert. Testosterone Treatments: Why, When,
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Rhoden EL, Morgentaler A. Risks of Testosterone-Replacement Therapy and
Recommendations for Monitoring. N Engl J Med 2004; 350:482-492 January 29, 2004