• Who Should be Treated?
• What Symptoms May Benefit From Therapy?
• What are the Risks of Therapy?
• What Forms of Testosterone Therapy are Available?
• Monitoring Your Levels
• How Long Before I Feel Results?

Who Should be Treated?

You should only be treated with testosterone replacement therapy if your blood test shows a low testosterone level. If your testosterone level is normal, treatment will not help your symptoms. For people 60 years of age and older, testosterone levels naturally decline, and the benefit of treating individuals of this age is uncertain at this time.
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What Symptoms May Benefit From Therapy?

• Low sex drive
  
• Problems with erections
  
• Reduced muscle mass and bone density
  
• Depression

Note: The above symptoms will not improve if your testosterone level is already normal.


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What are the Risks of Therapy?

• Increase in red blood cells
  
  • This can be beneficial if you have anemia (low blood counts). However, it can be potentially dangerous since too much blood can block your blood vessels and lead to a heart attack or stroke.
  
  
• Prostate effects
  
  • Testosterone therapy increases the volume of your prostate gland. To date, there have not been any studies showing that testosterone therapy increases the risk of prostate cancer. However, there is some theoretical concern because prostate cancer is treated by blocking testosterone. We should assume that the long term risk at this point is uncertain. If you have an enlarged prostate, referred to as benign prostatic hyperplasia (BPH), testosterone may worsen your symptoms, particularly if you are more than 50 years of age. If you have a history of prostate cancer, you cannot receive testosterone therapy.
  
  
• Skin reactions
  
  • These are most common with use of a patch; however, they lower with the use of a gel and are rare with injections.
  
  
• Infertility
  
  • This is common particularly in young men, but usually reversible after stopping testosterone therapy.
  
  
• Sleep apnea
  
  • This is a condition that disrupts breathing during sleep. Although uncommon, it is a reported side effect.
  
  
• Fluid retention
  
  • Although uncommon, you must use caution if you have a history of heart failure or kidney disease.
  
  
• Other
  
  • Acne, oily skin, increased body hair and flushing have also been reported.

All patients should be aware that there may be other potential long-term risks associated with testosterone replacement therapy which have not yet been detected. This has been noted in the case of estrogen therapy in women.


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What Forms of Testosterone Therapy are Available?

• Injections
  
  • Testosterone is injected directly into the muscle at prescribed intervals. Disadvantages of injections include pain from the injection, having to visit the doctor, and a potential change in energy level, mood and sex drive.
  
  
• Transdermal
  
  • Applied to the skin on your testicles or elsewhere on your body. The advantages include easy use and more uniform testosterone levels. Your energy, mood and sex drive may remain more stable compared to testosterone injections. A disadvantage is skin irritation. The testicular (scrotal) patch is applied to the scrotal skin once a day and worn continuously except when bathing. For an adequate amount of testosterone to be absorbed, the scrotum should be shaved twice a week, the patch should be warmed with a hair dryer immediately before application, and jockey-style underwear should be worn day and night to support the patch and prevent it from falling off. The nonscrotal patch, known as Androderm, is meant to be worn on the arm or torso.
  
  
• Gel
  
  • Gel, known as Androgel, is applied to the skin once a day. It offers convenient application with stable blood levels of testosterone; however, the primary disadvantage is its higher cost.

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Monitoring Your Levels

How often your testosterone level is monitored depends on the form (see above) of therapy you use. Your blood counts and prostate blood test may also be checked in addition to your testosterone level. When using testosterone therapy, keep track of any changes in your pattern of urination, and any difficulty you have with sleep, particularly loud snoring, difficulty breathing at night, and/or excessive sleepiness during the day.
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How Long Before I Feel Results?

This varies from patient to patient, but may take three to six months for results to be noticed.
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