Benefits of Testosterone Therapy in Men
Modern integrated medicine has progressed to a point where it can be reasonably stated that normalization of serum testosterone in men who are testosterone-deficient is likely to improve symptoms of fatigue, sexual dysfunction, weakness, or reduced muscle mass, and anecdotal evidence supports testosterone improving mood, sense of well-being, motivation, and osteoporosis. Although testosterone replacement does not work for all individuals it works for the majority of patients and therefore needs to be seen as a viable treatment option or medication not with the disdain of clinicians who are ignorant to be familiar with the benefits associated with testosterone replacement therapies. Just as menopause affects all women, andropause is real and affects all men at different ages.
Testosterone therapy may have a wide range of benefits for men, not only in the improvement of sexual symptoms but for a wide variety of metabolic and medical symptoms that promote overall health. The loss of fat and the gain in muscle routinely seen with testosterone therapy represents a positive change in body composition that has implications for cardiovascular and metabolic health. There are substantial observational and interventional studies that strongly indicate important links between testosterone and diabetes as well as testosterone and cardiovascular health. The instance of low testosterone levels is associated with 40-55% in active men with diabetes and has been shown to have reduced insulin resistance.
In addition, there are changing attitudes regarding testosterone therapy and prostate cancer. Originally, it was feared that testosterone therapy might convert occult prostate cancer into clinical disease, new evidence supports that serum testosterone appears unrelated to prostate cancer risk.
The goal of any treatment is to restore serum testosterone levels to normal (600-800 ng/dL) though lower levels may be adequate for symptom improvement in many men. Treatment options include topical gels, patches, injections, implantable pellets, and a buccal tablet. Gels and patches require daily application, injections are given intramuscularly every 1-3 weeks, and pellets may provide adequate serum testosterone concentrations for a range of 3-5 months. Serum testosterone monitoring is mandatory for any of the transdermal modalities since absorption is not uniform and dosage may need to be adjusted to reach therapeutic levels.
It is time that the medical community re-evaluates the health benefits of testosterone therapy. Just the word “testosterone” denotes negative connotations (i.e. athletes, body builders, virility) with many physicians when testosterone can be a solution for a variety of health problems for which evidence is lacking. Although there is still much to be learned, it is no longer acceptable to suggest that the benefits are uncertain or that these relate only to sexual function. Testosterone deficiency is a meaningful risk factor for serious medical conditions such as diabetes, atherosclerosis, metabolic syndrome, osteoporosis, and cardiovascular mortality.
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