As a result of advertising, more men than ever are asking their doctors about testosterone replacement. Replacement testosterone therapy in men 40 years and older who have low levels of natural hormone "is legitimate, when done legitimately," says John Morley, an endocrinologist at St. Louis University School of Medicine. But, he contends, giving testosterone to men with normal levels of the hormone, especially over the long term, holds unknown risks.
The normal range of testosterone is 300 to 1,000 nanograms per deciliter of blood. After age 30, men typically lose 1 percent of their testosterone per year. Testosterone levels fluctuate throughout the day, with the highest peak in the morning. To diagnose low T, a doctor ideally should take two blood samples between 7 and 10 a.m. Low T is generally defined as a testosterone level below 300, accompanied by one or more of the classic symptoms: low sex drive, soft erections, low energy and weight gain.
The known risks of testosterone therapy are enough to keep many doctors conservative about its use. About 40 percent of men receiving injections and up to a fifth of those using topical testosterone develop a high blood cell count, a condition known as polycythemia. Thickened blood increases the risk of blood clots, stroke and heart attack.
"The biggest worry is prostate cancer," Morley says. Small studies suggest that testosterone therapy probably does not cause prostate cancer, but it may aggravate a cancer already present. Morley says physicians treating low T should monitor patients closely for both prostate cancer and polycythemia.
Another side effect of testosterone could get overlooked in the doctor's office: infertility. Taking testosterone can shut down sperm production.
"This is a risk factor patients need to know about," says Jared Moss, a resident urologist at the University of Tennessee Medical Center in Knoxville, who recently reviewed the effects of rejuvenation hormones on sperm count. The data suggest that sperm counts can recover once testosterone is stopped, Moss says.
If you or a loved one have suffered a stroke, pulmonary embolism, heart attack or blood clot after undergoing testosterone replacement therapy, please call our office at (888) 606-5297 for a free consultation.