Dr. Udaya Kumar, Urology Today, 06/26/12

Decline in testosterone levels related to aging and other conditions can lead to sexual symptoms including erectile dysfunction, decrease in sexual desire or libido, reduced vitality and depressive moods.

In men with proven low levels of testosterone, replacement of testosterone has the potential to reverse many of the above symptoms and can lead to improved mental, sexual and metabolic health.

Prior to initiation of testosterone replacement therapy, it is essential that prostate screening is performed to rule out prostate cancer, as testosterone has the potential to stimulate the cancer growth.

Several forms of testosterone replacement are available. These include skin gels that require daily application, skin patches and injections. Injections are the most commonly used, as they are less expensive and require only three or four weekly administrations. Implantable subcutaneous pellets for four to six monthly administrations are also available.

A recent study by Dr. Michael Zitzmann at the Center for Reproductive Medicine and Andrology, Muenster, Germany, suggests that testosterone replacement may offer additional benefit by enhancing the efficacy of certain drugs used in the treatment of symptoms of benign enlargement of the prostate and improved metabolic health.

In his study of almost 1,500 men with testosterone deficiency, patients received injectable long-acting testosterone undecanoate over a nine- to 12-month period. Patients were monitored for any evidence of prostate cancer as well as sexual, mental and metabolic health. None of the patients developed any new prostate cancers.

While 65 percent of patients had erectile dysfunction at baseline, this number dropped to 19 percent after one year of treatment. Additionally, patients who were on drugs such as Proscar (finesteride) or Avodart (dutasteride) for treatment of symptoms of benign prostatic enlargement had improved responsiveness to the drugs after one year of treatment with testosterone undecanoate.

All mental and sexual scores improved, while the waist circumference also decreased from 100 cm to 96 cm in the treated patients. Dr. Zitzmann, presenting his data at the 2011 European Association of Urology Congress at Vienna, Austria said that the treated patients showed evidence of decreased visceral fat and diabetic markers such as HbA1c also showed improvement.

After 30 years of age, testosterone levels begin to decline gradually in most men. While many older men may attribute their decreased interest in sex simply due their age or to other related medical problems such as diabetes, depression or high blood pressure, a low testosterone level may be the main cause.

Men with excessive fatigue, weakness, feelings of depression and loss of sexual drive and have erectile dysfunction should discuss their condition with their physician. The physician will want to rule out other causes for the symptoms and can then perform a simple blood test to check their testosterone level. Patients with levels lower than 300 ng/dl may benefit from testosterone replacement.

However, it is important to remember that patients on testosterone replacement need careful monitoring of their testosterone levels, liver function, prostate health and blood count.

Patients can also take a testosterone health check on WebMD to assess their symptoms prior to initiating their discussion with their physician. The website provides useful information and tips about low testosterone levels.

Udaya Kumar. M.D., FRCS Urol, Dip. Urol (London), is certified by the American Board of Urology and the Board of Urology of U.K. and Ireland. He is a former professor of urology with University of Arkansas for Medical Sciences. Contact him at 3475 S. Suncoast Blvd., Homosassa, FL 34448 or 352-628-7671.