Testosterone therapy: Weigh the benefits and risks

Recently, the FDA began requiring manufacturers to change the labelling on products that treat low testosterone to include a warning about the possibility of an increased risk of heart attack and stroke. But there’s been a good deal of controversy and conflicting study results surrounding prescription treatments to boost low testosterone levels, so do the risks of these treatments outweigh the benefits?

An accurate diagnosis is the first step

As men age, their testosterone levels naturally decline, which can cause fatigue, decreased sex drive and a loss of muscle mass. Some men, however, have clinically low testosterone levels and experience additional symptoms that can interfere with their quality of life. These symptoms include erectile dysfunction, problems sleeping and depression.

To find out if your testosterone levels are clinically low, your physician will order a test to measure the level of the hormone in your blood. Less than 200 or 300 ng/dl of total testosterone is considered to be a low testosterone level. For the most accurate measurement, schedule your blood test in the morning when levels are at their peak. If your levels are low but don’t reach the threshold for a clinically low level, it’s wise to seek a second opinion from a specialist.

While testosterone treatments can help ease the symptoms of men with clinically low testosterone levels and lower their risk of osteoporosis, the FDA found that more than 20 percent of men who are taking these drugs did not have lab work that indicated that treatment was needed and appropriate. Some specialists have noted that the treatments provide less symptom relief for men whose testosterone levels are higher than 200 to 300 ng/dl.

What are the risks?

Some studies have found an association between the use of testosterone therapy and an increase in the risk of heart attack, stroke and death from all causes, especially for men with underlying heart disease. Other researchers have reported that the therapy is associated with an increased risk of heart attacks in men age 65 and older and in younger men who have a history of heart disease.

Other risks associated with testosterone therapy include:

• sleep apnea
• stimulation of non-cancerous growth of the prostate
• stimulation of existing prostate cancer
• limited sperm production
• blood clots
• breast enlargement

While there have also been studies that have found no increased risk of heart attack or stroke and even a decreased heart attack risk when men with clinically low testosterone levels undergo the therapy, more study is needed to determine the safety of this type of treatment and which patients it is medically appropriate for.

If you’re concerned about symptoms that could be caused by low testosterone levels, talk with your physician about all of the options available to manage these symptoms. In some cases, symptoms may be caused by other health problems, such as diabetes, kidney damage, changes in thyroid function, obesity, and the use of certain medications, such as corticosteroids.

There are steps you can take to improve your overall health and lower the likelihood that you’ll experience low testosterone levels at an earlier age. These include not smoking, maintaining a healthy weight, choosing a healthy diet, exercising regularly, getting adequate sleep, and managing stress.