Senior Health Testosterone Replacement Overview 8/20/2024 | By Howard LeWine, M.D. Determining the need for testosterone replacement is based on more than just blood levels. Harvard Health Publishing gives an overview of low testosterone level causes, symptoms, and treatments. Question: I wonder if my lower energy level and less sexual interest is related to low testosterone. How does a man know if he may need testosterone treatment? Answer: Testosterone is the sex hormone that gives men their manly qualities. Produced by the testicles, it helps to form traditional characteristics like a deep voice, facial hair, and muscle size and strength. It also fuels a man’s libido. Doctors define a normal blood level of testosterone as 300 nanograms per deciliter (ng/dL) and higher. According to the American College of Physicians, a man’s testosterone level declines about 1.6% per year beginning in his mid-30s. In addition to natural age-related decline, a significant drop in testosterone might also stem from damage to the testes, such as from an injury, an infection, radiation treatment, or chemotherapy. Testosterone blood levels fluctuate during the day. To get the most accurate reading, it’s best to have your blood drawn between 7 a.m. and 10 a.m., when testosterone is at its peak. Your doctor might recommend testosterone replacement therapy (TRT) if your level drops below 300 ng/dL and is confirmed by repeat testing. However, it’s not automatic. The first step is to determine if any symptoms attributed to low testosterone are related to something else that’s treatable. For example, symptoms like fatigue, trouble concentrating, and low sex drive could be caused by a poor diet, lack of exercise, and insufficient sleep. Also stress, anxiety, or depression can lead to the same symptoms as low testosterone. If troublesome symptoms and low testosterone remain after these paths are explored, your doctor then may prescribe short-term TRT. Men commonly first try a daily gel, cream, or patch applied to the skin (usually on the shoulder or thigh, which are easy to reach). TRT also can be taken as daily oral medication or weekly or biweekly injections. Keep in mind that TRT may not work for everyone or may have only a minimal effect. Another aspect to consider is that if you have a good response, you may need to stay on TRT indefinitely to maintain the benefit, as your body stops making its own testosterone while you’re on the therapy. TRT can have short-term side effects, such as acne, worsen sleep apnea, and ankle swelling from fluid retention. While TRT does not appear to increase the risk of developing prostate cancer, it does stimulate growth of men who already have it. Prior studies raised concern about cardiovascular risks related to testosterone use. However, a recent large clinical trial showed no increase in heart disease risk from TRT in men with proven abnormally low testosterone levels. Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu. ©2024 Harvard University. For terms of use, please see https://www.health.harvard.edu/terms-of-use. Distributed by Tribune Content Agency, LLC. Read more health articles on Seniors Guide: 6 Strange Changes of Aging, Plus Action Steps Read More Howard LeWine, M.D. Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.