Dr. Jacqueline Gerhart: Should I Be Worried About Low Testosterone?
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I was wondering if you would talk about "low T." I saw a commercial about how men can have low testosterone if they feel fatigued and are gaining weight, or if their libido is low, and they should talk to a doctor. Well, that's me. What should I do?
Dear Reader: I spend quite a bit of time as a primary care doctor talking about estrogen, progesterone and menopause. Less commonly, men ask me about their testosterone levels in response to aging.
A man's testosterone level fluctuates during the day, with highest levels in the morning, and lowest levels in the evening. A "normal" testosterone level depends on your age, since testosterone levels naturally decline as you get older.
During puberty, a man's testosterone levels are high, allowing for the deepening of his voice, the developing of his muscles and the transition of sexual characteristics from "boy" to "man." After age 30, testosterone levels slowly decline, and along with that can come symptoms of fatigue, depression, weight gain, decreased muscle mass and decreased libido.
If you suspect you may have low testosterone, first think if this is normal for your age. If you are 80 years old and are noticing muscle loss, this is normal. However, if you are 30 years old or younger and have the above symptoms, be sure to see your physician.
Your physician will do a history and physical exam to determine possible other causes for your symptoms. Then he or she will likely perform blood tests to look at your hormones, electrolytes, vitamin and mineral levels, and blood count. This is to look for other reasons for fatigue, such as low thyroid hormone, low iron or low Vitamin D.
A normal total testosterone level in the blood is usually above 300 nanograms per deciliter (ng/dL). If your level is lower than this, your doctor will have you repeat the test in the morning, around 8am, when testosterone levels are the highest. A second level of total testosterone less than 300 may indicate you have "low T."
If this is the case, your physician will likely suggest lifestyle changes - such as improving your diet and increasing exercise - to help with the symptoms of weight gain and fatigue. Mildly low levels of testosterone often can be tolerated without medications.
Medications and treatments often are given when the testosterone level is 200 or lower. If you have low testosterone and you and your partner are trying to become pregnant, testosterone injections may be helpful. If given every few weeks, they can stimulate sperm production. If fertility is not your concern, then testosterone is usually given through a daily gel or patch.
The benefits of testosterone treatment are decreased symptoms and decreased risk of osteoporosis and bone fracture. Testosterone treatments usually are not recommended for men with prostate cancer. It also is not frequently used for men with mild testosterone deficiency or for those at a natural testosterone level for their age. When testosterone treatment is used, we usually ask an endocrinologist specialist to help with treatment and monitoring.
Although there are tons of TV adds about low testosterone, don't self-diagnose too quickly. Talk with your physician to be checked for other disorders. If you are found to have low testosterone, work with your physician to come up with the most appropriate plan - which may or may not include treatment.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 05/15/2012