Testosterone replacement therapy

The male hormone testosterone is produced by the testicles and is responsible for the proper development of male sexual characteristics. It is also important for maintaining muscle bulk, red blood cells, bone growth, sense of well-being, and sexual function. Though inadequate testosterone production is not a common cause of erectile dysfunction, some men with low testosterone might see increased sexual functioning from testosterone replacement therapy.

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As a man ages, the amount of testosterone in his body gradually declines, starting after age 30. Other causes of testosterone deficiency include injury or infection to the testicles, chemotherapy or radiation treatment for cancer, genetic abnormalities, hemochromatosis (too much iron), pituitary gland dysfunction, medications including prostate drugs and steroids, AIDS, stress, and alcoholism. Testosterone deficiency can cause decreased sex drive, decreased sense of well-being, depression, concentration and memory difficulties, and erectile dysfunction.

Testosterone levels fluctuate in the body throughout the day, and a doctor may test the amount of the hormone in your blood several times to diagnose low testosterone. If your testosterone levels are low, your doctor may prescribe one of several different types of testosterone replacement: intramuscular injections, testosterone patches, or testosterone gels. Because oral hormones may lead to liver abnormalities, no pills exist in the United States that provide adequate levels of testosterone replacement.

Though testosterone replacement therapy is generally safe, it is associated with several conditions including acne, oily skin, mild fluid retention, stimulation of prostate tissue and increased urination, breast enlargement, worsening of sleep apnea, and decreased testicular size. Some laboratory side effects of testosterone replacement therapy include changes in blood cholesterol, increased red cell count, and a decrease in sperm count (which can produce infertility, especially in younger men).

Since testosterone may stimulate prostate growth, the hormone can also accelerate the growth of prostate cancer. It is important for all men considering testosterone replacement therapy to undergo screening for prostate cancer before starting treatment. Further, men with breast cancer should not take testosterone replacement therapy.