Image for andropauseThe male analog to menopause—or andropause—has been associated with menopausal-like symptoms, including weakened bones, decreased sex drive, and even hot flashes and irritability. While this condition is controversial, more and more men are asking their doctors for testosterone replacement therapy (TRT) prescriptions to alleviate some of these symptoms. But is TRT a safe and effective treatment for age-related declines in testosterone? And which men—if any—should be taking it?

Male Hormones Over Time

Testosterone is one of the male sex hormones—or androgens—responsible for the development of masculine characteristics. During puberty, testosterone initiates the enlargement of the penis and testes, growth of facial and pubic hair, deepening of the voice, increases in muscle mass and strength, and growth in height. In male adults, testosterone is involved in the maintenance of sex drive, production of sperm cells, male hair patterns, muscle mass, and bone mass.

As men age, their production of testosterone naturally declines. But this age-related hormonal decline is much less dramatic in men than in women. During menopause, the production of estrogen and progesterone decreases sharply in women. The drop in testosterone is much more subtle in men.

Age-Related Changes in Men

Low levels of testosterone have been associated with weakened bones, diabetes and cardiovascular disease rates, diminished sex drive, and muscle loss in aging men. Signs of low testosterone levels include decreased sex drive, erectile dysfunction, low sperm count, reduced fertility, and increased breast size. Some men may even experience menopausal-like symptoms, including hot flashes, irritability, difficulty concentrating, and depression.

If your doctor suspects your testosterone levels are low, a simple blood test can check it. But since testosterone levels fluctuate widely throughout the day, a single test may not be able to diagnose testosterone deficiency. Generally, the acceptable range of levels is between 250-1,000 nanograms per deciliter (ng/dL) for total testosterone.

While testosterone does decline with age, diseases and conditions of the testes, pituitary gland, hypothalamus, and various genetic conditions may also cause reductions in the production of testosterone. If your testosterone levels are abnormally low, your doctor may perform additional tests to look for damage to the testes, or hypothalamic or pituitary gland diseases. If one of these diseases or conditions is detected, treatment may resolve the testosterone deficiency, or TRT may be indicated. In addition, some medications may cause the testosterone level to drop. Diminished testosterone levels are a known complication of chronic opioid therapy for chronic pain.

Testosterone Replacement Therapy (TRT)

There are different delivery methods of TRT for clinically low testosterone levels in otherwise healthy men, such as pills, injections, patches or gels, and a tablet that adheres to the gum surface. TRT might benefit men who suffer the symptoms of low testosterone in a number of ways, including:

  • Increasing sex drive
  • Restoring erectile function
  • Improving mood
  • Increase bone density
  • Maintaining beard growth
  • Increasing muscle mass
  • For years, menopausal women took hormone replacement therapy (HRT, a combination of estrogen and progesterone) to relieve symptoms of menopause and increase bone density. However, HRT has been linked with increased risk of breast cancer, heart disease, stroke, and blood clots. It is not clear at this point if testosterone therapy effects cardiovascular outcomes in men.

    There are also concerns that TRT may increase the risk of prostate enlargement, and prostate cancer. So far studies have not shown conclusive evidence of this.

    If you are considering this therapy, talk to your doctor about the potential harms and benefits.