Testosterone therapy

Proceed with caution with testosterone therapy

 

bmedina@elnuevoherald.combmedina@miamiherald.com

Maybe you have seen the television commercials or newspaper ads promoting the cure to “Low T,” of low testosterone levels.

More and more companies are targeting older men with products for testosterone replacement that promise to help them “become young again.”

Testosterone is the hormone responsible for the normal development of male sex organs and it also plays a major role in men’s sexual drive, energy levels and attitudes. As they age, men may experience a decrease in their testosterone levels, which can translate to a low libido, depression and lack of motivation, reduced muscle strength and bone density, and in some cases, memory loss.

Although testosterone replacement therapies have been around for more than 20 years, there has been an increase in the number of products available and in the demand for those products, two specialists said.

“Some studies show that 15 to 20 percent of men will experience a decrease in their testosterone levels at some point in their lives,” said Dr. Bruce Kava, associate professor of urology at the University of Miami’s Miller School of Medicine. “We are seeing more and more now that as obesity rates go up the testosterone levels decrease. That is because body fat causes testosterone to metabolize faster.”

But while there are replacement treatments that can do the trick, they have to be done properly and under a doctor’s supervision, experts advised.

“I don’t recommend ordering testosterone supplements over the phone or on the Internet. Many of those products aren’t regulated by the Food and Drug Administration,” said Dr. Joseph L. Esposito, a urologist with Baptist Hospital who has provided testosterone replacement therapy for close to 20 years. “The most important part is to determine that the patient has low testosterone levels to know if they need a treatment. If you are ordering something on your own, most likely you are not seeing a doctor that can tell you if you need a replacement in the first place.”

Low testosterone levels can be determined through blood tests. Esposito recommends that the patient gets two or three blood tests, preferably in the morning.

“Testosterone is secreted on a daily basis and it is at its peek in the earlier hours of the day,” Esposito said. “If you wait until the afternoon it can show up artificially low.”

Kava agrees. Patients who present symptoms such as low libido and lack of energy do not necessarily have low levels of the hormone, he noted.

“Many times it just means that we are not eating well or taking good care of our bodies,” he said.

More worrisome is that testosterone replacement therapy can affect men with prostate problems, including prostate cancer. The excess testosterone levels can cause the prostate to grow, which can hurt someone with prostate cancer who hasn’t been diagnosed, explained Kava.

High levels of testosterone can also affect the ability of the testicles to produce sperm, which can lead to fertilization problems.

“Many young men are using testosterone for muscle growth,” Esposito said. “But that can have short- and long- term negative effects. The levels of testosterone in the body should be natural.”

Another short-term side effect can be sudden aggressiveness, Kava said.

“That can be due to an elevation in the blood count,” he said.

If you do need it

There are three main options to get testosterone in the body, once the hormone deficiency has been diagnosed.

The treatment can be administered through an injection, patches, gels and intramuscular pellets. Kava said that specialists are moving away from testosterone pills because they haven’t been as effective and some studies linked the oral supplements to liver cancer.

Patients who opt for the gel apply it daily in their bodies, usually the shoulder or stomach, and should wait for 10 minutes until it is absorbed. Then, the body slowly releases the synthetic hormone into the bloodstream.

The injection can be self-administrated, usually every two or three weeks. However, Kava and Esposito said that a disadvantage of that treatment is that the diffusion of the hormone in the body doesn’t go smoothly.

“It shows very high picks once it is administered but then it has very low drops of testosterone through the week or two before you get the next injection,’’ Esposito said.

The pellets’ implant requires a minor surgical procedure, usually placed under or near the buttocks.

Doctors said that once a person is undergoing testosterone replacement treatment, he is still not on his own. Esposito said monitoring patients helps him to make sure that the hormone levels are regular and that the treatment is working.

“Under the treatment, a person needs to be monitored by a doctor every six months to a year,” Kava said.

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