Why Treat Low Testosterone?


Chris Iliades, MD

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Why treat low testosterone? There’s no simple answer to this question.

Testosterone therapy isn’t new. In fact, it has been around since the 1940s. But an editorial published in JAMA (the Journal of the American Medical Association) noted that many unanswered questions remain about why and when to treat low T.

One guideline is whether the benefits of testosterone therapy outweigh the risks. That's important because there may be more risks than previously thought. A recent trial of testosterone therapy was stopped because the rate of heart attacks among the men being treated was higher than it should have been.

Experts agree on the need for more studies in larger groups of men over longer periods of time. Only then will there be a clear answer to the treat-or-not-to-treat question.

Health care providers are writing more than a million prescriptions for testosterone every year. That means they're finding reasons to treat low T.

Current Guidelines

The most up-to-date guidelines for when to treat low T are from the Endocrine Society. The guidelines say that low T should be treated if you have an early morning blood test that shows low testosterone and you have symptoms of low T.

The guidelines also list other medical conditions where the risks of low T therapy outweigh the benefits. These include prostate cancer, sleep apnea, and heart disease. Discuss these with your health care provider.  

The U.S. Food and Drug Administration approved testosterone treatment for men with low testosterone and at least two symptoms of low T, such as:

  • Lack of sex drive

  • Fatigue

  • Weak bones

  • Depressed mood

  • Loss of muscle

  • Erectile dysfunction (ED)

The Benefits of Treating Low T

If you meet the guidelines for treatment and you and your health care provider decide the benefits outweigh the risks for you, there are good reasons to treat low T.

Possible benefits you may experience include:

  • Reduced weakness

  • Less chance of falls and fractures

  • Improved mental ability

  • Improved sexual desire

  • More energy

  • Better quality of life

According to the American Urological Association, you may also experience:

  • Better sleep

  • Better erections

  • Decreased body fat

  • Increased muscle mass

  • Stronger bones

Bottom Line on Treating Low T

About 40% of men older than 40 have low T. If you have low T, with symptoms that are decreasing your enjoyment of life, you need to weigh the risks and benefits of treatment. There could be a big upside to treatment.

Once you start low T treatment, you need to continue it or your testosterone level will drop back down. If you decide to give it a try, remember to keep working closely with your health care provider. Your risk-benefit equation may change in the future.

Key Takeaways

  • Low testosterone on a blood test is not enough reason to treat low T.

  • The guidelines for treatment include a low T with an early morning blood test and symptoms of low T.

  • If you meet the guidelines, benefits can make treatment worthwhile.

  • You and your health care provider should continue to weigh the risks and benefits of treatment over time.
Smiling Man

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Mar 25, 2016

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Medical References

  1. Cappola, AR. Testosterone Therapy and Risk of Cardiovascular Disease in Men. JAMA2013;310(17):1805-1806.
  2. Are Higher Testosterone Levels Associated with Greater Heart Risk? University of California San Francisco. https://www.ucsf.edu/news/2010/08/5999/testosterone-heart-risk-research-raise-concerns-about-testost...
  3. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-59.

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