Testosterone for Men

Steven Windley MD

This is a “to the point” article on what I share with my patients as we discuss the pros and cons of testosterone treatment for men. This conversation typically comes about because of a patient complaining of: fatigue, being tired often No drive, no motivation to do the things they would like to do Feeling more grumpy or frustrated Loss of muscle mass Noticeable loss of stamina with exercise and even daily activities General weakness Lower libido This list does not include every symptom but many of the common ones. I intentionally put low libido last because many of the guys I treat may have that concern, but they are just as concerned, and often more concerned, that they have not get up and go. They are people who want to be active. They want to workout, exercise, and do activities with their friends and family but they just do not have the stamina or drive to make it happen. They are not depressed, they just energetically don’t have it. We try to talk about various factors that may play in to this such as sleep schedules, dietary habits – especially too much sugar, stress, lack of exercise, toxins, as well as other hormones and conditions. We look at labs to see if low testosterone is a possibility along with other potential causes such as blood sugar and thyroid. If the testosterone labs are low and correlate with symptoms, we talk about options for testosterone.

Some guys prefer to start simply by making much needed dietary changes and trying to get in some daily movement/activity. Taking the diet from terrible to well above average is necessary and can really help testosterone levels for some guys. In other cases, extra supplements may be added such as magnesium, vitamin D, zinc, or ginseng to help with testosterone production and energy in general. Other conditions that can negatively affect testosterone include blood sugar issues including diabetes or pre diabetes, sleep apnea, chronic pain medication, and chronic stress. Chronic stress in particular can really weigh heavily on testosterone production, and I discuss with patients to consider this as a part of their situation if applicable. If symptoms are really prominent, and/or the above has not been enough, I talk about testosterone treatment. Testosterone can be done as a cream or gel through the skin or by injection. Some guys do not want to mess injections and prefer the topical creams and gels but I do find that the injections work more consistently for most guys. There are various opinions on how to do injections, in part because people are different and may need different plans. In general I want my patients to inject weekly. By day 7, using an appropriate dose, the testosterone should be getting down fairly low and ready for the next injection. I think that it is good to have some rise and fall of the levels to help keep the receptors primed for the next shot. I do not want guys having super high levels but I do want them to be balanced. Balance is always the key with hormones, including testosterone. Too much is not better. I check levels in a couple of months and compare that with how their symptoms are doing and adjust again if necessary. Based on those labs and patient response we will decide on the next round of testing but it typically balances out pretty quickly.

I do describe potential cons to the treatment. One of the biggest problems with testosterone is focusing just on the injection and doing nothing else to improve lifestyle. Testosterone is part of the solution but it is just part. Diet needs to be improved, and there needs to be some type of exercise plan. If a man does any type of testosterone and then just sits around, much of the testosterone will convert to estradiol (estrogen) in the fat cells and he may be worse off. Patients need to move and they need to eat veggies and less sugar to get the most out of treatment. The other big issue is using the wrong dose – too much. The right dose of testosterone can really boost stamina and drive and even help mood. Too much can cause, acne, increase in estrogen, and cause an overproduction of blood. It will also affect any production by the body, shutting that production down – and potentially shrinking the testicles. The term “roid rage” comes from guys abusing testosterone – and that is sad on many levels – that will shut the body’s own production down and they potentially throw their hormone balance off forever. Overproduction of blood can happen at more reasonable levels and does need to be watched. The treatment may included adjusting the dose and blood donation. Through the years, various sources have questioned prostate cancer risk and testosterone replacement. Dr. Abraham Morgentaler from Harvard University has become one of the world’s experts on this conversation. Opinions have changed through the years, swaying away from testosterone causing prostate cancer, perhaps in some cases even being protective, to avoid giving testosterone to a man who has active prostate cancer. I watch PSAs in these patients, checking a baseline and monitoring to make sure it is not rising too quickly. Fortunately, testosterone at the right dose, in a man who is not known to have prostate cancer has done well in this area in our clinic. I don’t treat men with active prostate cancer with testosterone Testosterone can be very helpful for some men. It needs to be done with a healthy diet and regular exercise. It is not for every man, but many of my patients have found it beneficial – sometimes a “game changer” for their health.