Low Testosterone Among Older Men

Approximately 5 million American men have low testosterone. This hormone is responsible for maintaining the attributes of a typical adult male, including sex drive, sperm production, pubic and body hair, muscle, and bone mass. As men age, their testosterone level typically decreases gradually by about 1 percent after the age of 30, and they may experience associated symptoms. This is sometimes referred to as “andropause.” 

I caught up with Lisa Little, RN, and Director of Des Peres Hospital's Senior Care Clinic to review the symptoms and treatment options for low testosterone in older ment.

Symptoms of low testosterone in adult men typically include:

• Decreased sex drive
• Problems with erections
• Lower sperm counts
• Enlarged breasts
  
  

Some men also could experience hot flashes, difficulty sleeping, depression, greater irritability and increased urination. Severe or prolonged cases of low testosterone may cause hair loss, lower muscle bulk and strength, weaker bones, smaller testes, decreased energy and increased body fat.

In addition to aging, low testosterone may be caused by trauma, testicular inflammation or tumors, chemotherapy or radiation treatment, genetic defects, certain medications or pituitary disease. If at any time there is an unusual decline in testosterone, you should speak with a doctor about possibly taking supplemental testosterone.

A low testosterone level may be diagnosed following a physical exam, medical history review or blood tests. During the physical exam, a doctor will look at the amount of body hair, size of the breasts, penis and testes, check for lumps in the testes and scrotum, and test the ability to see in all directions. A medical history can reveal if a man has a current or recent illness, any genetic diseases in the family, taken certain medications or experienced any stressful events. A blood test can reveal if testosterone levels are within the normal range of 300 to 1,000 nanograms per deciliter (ng/dl). 

If low testosterone is confirmed, it can be treated with hormone replacement therapy. This treatment can help increase sexual interest, restore erectile function, improve moods, maintain masculine characteristics, and increase lean muscle mass and bone density. Testosterone may be replaced using pills, injections, patches, gels or tablets. The method selected will depend on several factors, including the cause of the problem, patient preference, ability to tolerate medications and cost.

Pills are generally not the treatment of choice because they can cause potentially serious adverse side-effects on the liver. Injections can be painful, but they only need to be given every one to three weeks. Patches or gels are both easy to apply and provide a continuous delivery of testosterone. Usually they are placed on the back, abdomen, upper arm, thigh or scrotum. However, women and children should not touch the application site, and there could be complications with skin reactions. Tablets that need to be changed about every 12 hours can be placed in the mouth where the gum meets the upper lip. The tablets can cause mouth irritation and affect taste, but these side-effects usually go away after one day to two weeks.

All men taking hormone replacement therapy are at risk for breast enlargement and should be closely monitored for signs of prostate cancer. They should report any problems with breathing, especially while sleeping, to their physicians.

For more information about low testosterone, talk with your doctor or call the Senior Care clinic at 314-966-9313 for a referral to a geriatrican.