No Magic in Testosterone Replacement Therapy

Lackluster sex drive or lagging energy may not be caused by low levels of the hormone.


Maybe your sex drive is stuck in neutral, or your boundless energy has given way to sluggishness, or your taut torso is slowly softening. No guy likes to lose his edge. Could the problem be low testosterone? Why not jack it up with a gel, a patch, or a pellet implanted beneath the skin?

Not so fast. Lobbying a doctor for a dose of the male hormone before looking for other reasons for your problem is a bad idea. If low testosterone isn't the culprit, focusing on it wastes time and money better spent on finding the real cause, perhaps a circulatory condition, that could pose a greater threat to your health. And even if your testosterone is slightly low, there's no guarantee that kicking it up pharmaceutically will help, says Peter Snyder, professor of medicine at the University of Pennsylvania School of Medicine who has studied testosterone for 35 years. "There are people who are looking for the Fountain of Youth," he says. The reality, he says, is that they "are not acting on the basis of evidence."

Current research hinting that a testosterone hike has health benefits for the average man is "tantalizing but by no means conclusive," says Snyder, who is directing the "T-Trial," a $47 million study now recruiting participants that should take a large step toward the ultimate answer. Sponsored by the National Institutes of Health, the trial will follow 800 low-testosterone men age 65 and older ­with a possibly related physical, sexual, or other problem for two years to see how much they benefit from a testosterone gel supplement. Evan Hadley, director of the division of geriatrics and clinical gerontology at the NIH's National Institute on Aging, estimates researchers will publish results in about six years. If the benefits are significant, a larger trial will assess risks. That will take another six years.

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Until then, the best course is to give your doctor a chance to figure out what's going on. You will be quizzed in detail about your symptoms and your testosterone will be measured. The level in a man's blood typically falls between 300 and 1,000 nanograms, or billionths of a gram, per deciliter of blood, and decreases with age. Readings vary greatly by individual, making it difficult to pin down a "normal" amount. However, a consistent level of 250ng/dL for a 30-year-old or 150 for a 75-year-old, based on at least three blood tests early in the morning, when levels are highest, will get a doctor's attention and strongly hint you'll see some results on treatment, Snyder says. But those levels are unusual. Many men fall into a grey area just below 300. "For them, we just don't know" whether treatment will help, Hadley says. Because of this uncertainty, participants in the T-Trial must have levels below 275ng/dL.

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If low testosterone isn't your problem, there's no shortage of other candidates. Muscle weakness could be due to poor leg circulation. Depression can diminish interest in sex. Huffing and puffing after a couple of flights of stairs could simply mean you're in denial about the 25 pounds you've picked up over the years, or perhaps you're just not as athletic as you used to be. "Aging is not a disease," says Adrian Dobs, a professor of medicine at Johns Hopkins Medicine in Baltimore and an expert in testosterone. Just because your workouts don't seem to maintain your once-muscular "Mr. America" physique doesn't mean a testosterone patch is the answer, she says.

[ Low Testosterone Raises Heart Death Rates in Impotent Men] Even before scheduling an appointment with a doctor, says Edmund Sabanegh, director of the Center for Male Infertility at the Cleveland Clinic, think about what you could do on your own that could help. A healthy diet and regular exercise are at the top of the list. "Do the things that our moms told us to do," says Sabanegh. Stress, alcohol, and steroid use can also depress testosterone levels.

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