Men: Who Needs Testosterone Replacement

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The decision to treat a man with testosterone (T) is not a slam dunk decision based on one test like the commercials for low T depict. Men come to me at any age over 40 (usually) with various levels of testosterone, medications that may affect testosterone levels, other illnesses that interfere with sexuality and T levels, as well as various viewpoints on taking a hormone or a “ medication” to replace what they used to make naturally. The initial decision to treat is dependent on his symptoms, blood levels of T and Free T, and levels of other hormones that affect T levels.

Before I see a patient I look at his information and decide if I can help with T pellets or not. Often I view lab and history and make an interim decision: to stimulate T at this time knowing that in the near future it will not benefit him and T will be the only choice. Those treatments can be done without T pellets, so I make sure the patient knows he is coming in for a treatment other than T beforehand so he is prepared.

So let me review the details of how I get to this decision. A patient who sees me for TDS must have 3 or more of the following symptoms of low testosterone:

Lack of libido, fatigue, insomnia, erectile dysfunction (ED), depression, loss of muscle mass, loss of stamina, hot flashes, osteoporosis, migraines, anxiety attacks, decrease in mental acuity, loss of motivation, osteoporosis loss of balance, and irritability. Blood tests also rule in or out the presence of TDS, as well as reveals the patient’s “stage” of testosterone loss. Interpretation of tests is always key to this step.

To make an accurate determination of TDS, Blood tests several for hormones must be drawn, fasting and in the morning when T is the highest. The tests include Total T, Free T, Estrone, FSH/LH, DHT. In the interpretation of the blood test results lies key to successful diagnosis. The normal depicted on the print out are not optimal levels of these hormones, but levels that are average for your age. In no way do they indicate health or ability to function as a man. Through research I know that the true Low total Testosterone blood level is below 400 ng/dl, and the low free testosterone blood level of less than 129 pg/ml. If you have both of these under the lowest optimal level and have symptoms, then you are a candidate for T replacement.

In some circumstances the man in question is young and can have his testosterone stimulated, or he has a hormonal imbalance that when treated will result in a higher testosterone level. I do not begin by treating these patients with testosterone. Treating “what ails them” is what I have successfully done and that is the subject of our next Blog.