There has been much debate over the past few years on the notion of whether to treat men with low testosterone levels.
While the debate pertains to the risk benefits of testosterone treatment, the data positively shows that as men age, their total serum testosterone level declines. According to our research, TT (total testosterone) level begins to decrease during the third decade of life and gradually declines by 0.4-2.6 percent annually.
By age 60, 20 percent of the general population has been termed testosterone deficient. After hearing these statistics you may be asking yourself, why isn’t this condition being treated more readily if it is so prevalent?
The answer to the above question is a very complex one, which has yet to be clinically defined. However, many physicians are reluctant to prescribe testosterone therapy, as they have been educated in the past that elevated levels of serum testosterone may lead to metastatic prostate cancer. This idea stems back to 1942, when researchers by the names of Huggins and Hodges discovered the correlation between low testosterone (<50ng/dl) and a reduced rate of metastatic prostate cancer. Ever since this study became the gold standard, physicians have strayed away from treating testosterone deficiency, in fear of inducing the growth/division of prostate cancer cells.
However, more recent studies question the original data produced by Huggins and Hodges, as they have been unable to demonstrate a positive relationship between testosterone therapy and an increased risk for developing prostate cancer, or prostate cancer recurrence. In fact, these studies looked at men who had been previously treated for prostate cancer either through radical prostatectomy, brachytherapy, or radiation and who were subsequently given testosterone therapy to treat symptoms of testosterone deficiency.
Of note, those men who received testosterone therapy had low-grade prostate cancer without evidence of metastatic disease. Eight out of the nine studies that were reviewed, again, did not show significant recurrence of disease with the presence of testosterone therapy, though did have a positive impact on treating symptoms of androgen deprivation.
Now we must take what we have learned from both Huggins and Hodges research back from 1942, as well as our recent research when making an informed decision on whether to treat symptoms of low testosterone. These symptoms generally include: hot flashes, fatigue, weight gain (especially around the trunk), depression and decline in memory. In addition, a positive correlation between testosterone deficiency and high cholesterol, diabetes, and osteoporosis has been established, and again requires medical professionals to weigh the risk-benefits of treating testosterone deficiency.
There are multiple treatment options when it comes to testosterone therapy and it is important to discuss with your physician the best method for you. Currently available are transdermal gels/patches which provide a dose of 5 mg daily, intramuscular injections at a dose of 200 milligrams every two weeks, or subcutaneous pellets (pellets which are implanted just under the skin) which provide more long term treatment, at a dose of 450-900 mg every three to six months. The goal of treatment is to re-establish “natural”, physiologic levels of total testosterone and free testosterone. Along with careful monitoring of testosterone levels, other hormones like estrogen and dihydrotestosterone must be evaluated to ensure optimal levels.
To conclude, just like women, men undergo hormonal changes as they age causing uncomfortable symptoms and mood changes. Due to the infamous study conducted by Huggins and Hodges back in 1942, many physicians are hesitant to prescribe testosterone therapy regardless of what recent literature reports. However, currently the only contra-indications to prescribing testosterone therapy are: a prior history of aggressive (metastatic) prostate cancer, breast cancer, or blood disorders causing elevated red blood cells. If you find you are a candidate for hormone therapy, it is important to speak with you doctor and discuss the various treatment options.
Should you decide to undergo therapy, remember to get your annual digital rectal exam, as well as PSA (prostate specific antigen) screening to monitor for change.
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team and the chief medical correspondent for am970 in New York City. Learn more at roboticoncology.com. Visit Dr. Samadi's blog at SamadiMD.com. Follow Dr. Samadi on Twitter and Facebook.