Most studies of testosterone therapy have demonstrated an improvement in libido and sexual function in men with hypogonadism. Researchers have found that low testosterone treatments increased sexual interest and increased the number of spontaneous erections. However, testosterone replacement may not improve erectile dysfunction if there are other causes of the condition.In addition to its effect on sexual domains, testosterone replacement has been shown to benefit mood, reducing symptoms of depression, anger, fatigue and confusion. Other research suggests that treatment may have beneficial effects on bone mineral density. Further studies in these areas are needed.
What type of testosterone products are available?
In the U.S., several forms of testosterone replacement are approved for use. The most common forms include injections, pellet implants inserted under the skin, and transdermal gels. Interest in these products has risen dramatically in the last decade or so. Your physician will discuss the pros and cons of each form of application.
The American Association of Clinical Endocrinologists recommends that patients receiving testosterone replacement be monitored every 3-4 months during the first year of treatment. Physicians may also suggest an initial follow-up visit after one or two months. This is encouraged to assess how treatment is working and to determine if a higher or lower dose is needed as well as yearly follow-up.
Men undergoing testosterone replacement should also have the following assessments: hematocrit and hemoglobin levels to measure the amount of red blood cells, cardiovascular parameters such as lipid levels and blood pressure, and periodic follow up exams including PSA (prostate-specific antigen) and digital rectal exam to monitor the effect of treatment on the prostate.
Common Side Effects to Testosterone Therapy
Testosterone replacement is generally well tolerated. There are four major issues that should be considered when deciding whether or not to take testosterone. These include a worsening of sleep apnea, polycythemia (an increase in red blood cells in the blood), liver toxicity, and effects on the prostate. There is also the potential for some minor side effects such as acne, increased body hair, and mild fluid retention.
There has been concern that testosterone might increase the risk of heart disease in men, based on the fact that men often develop heart disease earlier in life than women, and that perhaps testosterone, the major male hormone, was somehow to blame. However, studies have shown that men with higher testosterone levels are less likely to develop heart disease. In fact, testosterone can actually increase the blood flow to heart muscle, and often improves cholesterol levels.
Is testosterone safe?
Testosterone in men has been studied by researchers for decades. In February 2014, however, the The U.S. Food and Drug Administration (FDA) announced its plan to reassess the safety of FDA-approved testosterone products. The decision stems from concerns over two recent studies that suggested increased risk of heart attack, stroke, and death for men on testosterone therapy. Several medical societies including the International Society for Sexual Medicine have since released a response to these concerns stating that when weighing the entirety of available medical research, there is no compelling evidence that testosterone therapy increases cardiovascular risks.