Should I consider Testosterone Replacement Therapy?

Testosterone is the primary sex hormone in men. It is responsible for the secondary sexual characteristics we see develop in boys during puberty, and has profound physical and psychological effects on our bodies throughout our lives. Testosterone stimulates sperm production as well as sex drive. It also helps build muscle, minimise body fat, makes us hairy, (as well as lose hair on our heads), changes the way we think, and improves mood and memory.  Testosterone affects all aspects of the male body both physically and mentally, and is crucial in helping us maintain a good quality of life.

Dr Jeff Foster
Dr Jeff FosterMedical Director & Male Health Lead

Dr Jeff Foster is a Men’s Health specialist and one of the founders of H3Health.

You can find out more about Dr Foster by viewing his latest articles and biography .

So why might my testosterone levels have changed?

Testosterone production typically starts to decrease by about 1% per year from the age of 30.  However, the rate and severity with which testosterone levels drop in practice, is highly individual and can be affected by a range of external factors.  Low testosterone is relatively common in the over 40 age group, affecting up to 12% of men aged 50 and over, and with prevalence increasing each year.   Those more likely to suffer from testosterone deficiency are men with pre-existing health problems such as diabetes (up to 50% of men with type 2 diabetes have low testosterone levels), obesity, high blood pressure, raised cholesterol levels, heart disease, and chronic inflammatory conditions (such as asthma or arthritis). Some prescription medications will also lower testosterone production.

Symptoms of testosterone deficiency may include a decrease in libido, difficulty in achieving and maintaining an erection, tiredness, reduced muscle mass, increased body fat, mood swings, or just feeling like everything is that bit harder. Importantly, testosterone deficiency is not just a physical disorder; it can have a devastating impact on mental and emotional wellbeing.

The key factor is to decipher why the levels are low and then in some cases, testosterone levels can be restored by making lifestyle changes, for instance changing the way we exercise, improving diet, avoiding consuming large amounts of alcohol, and even reducing stress levels (this is because during anxiety or stress the body produces high levels of cortisol which directly suppresses testosterone production).  Sleep is another important factor in testosterone production; although the ideal amount of sleep varies from person to person, one study found that sleeping only 5 hours per night was linked to a 15% reduction in testosterone levels.  We should all be aiming for a minimum of 6-7 hours per night.

What should I do if lifestyle changes alone don’t seem to be making a difference?

In patients where making lifestyle changes are not enough to restore normal testosterone function, the good news is that testosterone replacement therapy (TRT), is a safe and highly effective treatment in most men. There are several ways to administer TRT: topical gels, creams, and short, medium, or long-acting injections.  Provided it is monitored and administered correctly, not only is TRT safe, but it can reduce the risk of many illnesses, and actually improves the overall health risks for men.

It is important to stress that TRT does not cause, and cannot cause prostate cancer, it does not lead to heart attacks, and every patient should be fully assessed and counselled before starting any treatment.  Some clinics will advocate that one type of TRT is the “gold standard” and that method, preparation, or therapy should always be used.  However, in reality this is not the case.

The best form of TRT is one that works for you. It needs to be a combination of a treatment that is safe, based on individual risk, easy to administer, and provides effective and positive results.

Photo by Vitolda Klein

So what should you do if you think you’re suffering with low testosterone?

If you suspect you might be suffering with low testosterone, it is important to get it checked.  By seeing a Men’s Health specialist, not only could treatment make you feel better, but it might also reduce the risk of illnesses occurring in the future.