It used to be that men could blame their lack of energy and decreasing libido on getting older. But not any more. If you’re a man age 50 or older who is tired for apparently no reason or has diminished sex drive, there’s a good chance that your levels of the hormone testosterone are lower than normal — and you could benefit from testosterone therapy.

Until recently, many doctors didn’t fully understand the importance of enough testosterone. But now, most physicians are aware that low testosterone (also called “low T”) has many negative effects that go well beyond reduced energy and libido.

Getting a testosterone test is easy and inexpensive. If your T levels are low, testosterone treatments are highly effective at relieving specific symptoms and improving overall health.

Benefits of Testosterone Therapy

Giving testosterone to men with low T has been shown to…

Improve libido by acting on T receptors in brain regions associated with sexual desire.

Improve erection quality by activating T receptors in the penis. In one study, 60% of men on T therapy reported improved erections.

Boost energy. Men report an increased sense of drive and well-being.

Improve body composition by increasing muscle mass and reducing body fat. In one study, men who used T gel, a testosterone treatment, for six months and did not exercise or change diet, added an average 4.4 pounds in muscle and lost 1.75 pounds of fat.

Increase bone density. Studies show that men with low T are at increased risk for bone fractures and that bone density improves measurably in men with low T who get testosterone therapy.

Prevent disease. Normal T levels reduce the risk for diabetes and coronary artery disease.

Increase longevity. Studies show that men with normal T levels live longer, on average, than men with low T.

Testosterone therapy is safe for most men. For decades, it was believed that increasing testosterone made prostate tumors grow. That’s recently been disproven, in part by research that I’ve conducted personally. If you have low T and no signs of prostate cancer, such as an elevated prostate-specific antigen (PSA) level or enlarged prostate, the data suggests that there’s no risk in testosterone therapy. Even men with abnormal PSA levels may receive testosterone therapy if a biopsy is negative. I also offer testosterone treatment to men with low testosterone after they have been successfully treated for prostate cancer.

Getting Tested

In my opinion, all men age 50 and older should have their testosterone level screened as part of their annual physical exams. I also recommend screening when men have significantly reduced sex drive… low energy for no apparent reason… difficulty achieving or maintaining an erection… decreased muscle mass and/or increased body fat, especially around the midsection (declining testosterone may play a role in the normal changes that come with aging)… loss of height (a sign of tiny fractures in the vertebrae due to osteoporosis)… increased irritability… and/or lack of motivation.

Important: Be sure to ask for both testosterone blood tests…

  • Total testosterone is the standard test that’s been used for decades. It will indicate if your total testosterone is subnormal (less than 350 nanograms/dL). But it does not indicate the amount of testosterone available to the body. That’s why it’s important to also get a second test.

  • The analog free T test is the most common and reliable test to measure free testosterone, the amount of testosterone that is in the bloodstream and biologically available (not bound to any carrier proteins). A level less than 1.5 picograms/dL indicates that you have low T and could benefit from testosterone therapy.

    • Note: The tests are not affected by diet, exercise or sexual activity prior to having blood drawn.

    Testosterone Treatments

    If you have low T, there are several effective treatments that can be administered by your primary care doctor or by a urologist…

    Testosterone gel (AndroGel, Testim) is the most widely used treatment, and the one I prescribe first. The usual starting dose is five grams, rubbed into the upper arms and shoulders once a day. It takes about two hours for the gel to be absorbed, during which time men should avoid skin-to-skin contact with others.

    The gel is completely absorbed, but the amount of testosterone that actually enters the bloodstream varies from person to person, so you must have your T levels checked a few weeks after starting treatment so the dosage can be adjusted if necessary. If this test still shows low T, upping the dosage or switching brands can often help. Gel therapy costs about $300 per month. Insurance may cover the cost, depending on the state you live in.

    Injections. Some men don’t absorb testosterone from the gel even in high doses. In these cases, I usually prescribe testosterone injections — typically 200 milligrams every two weeks. They’re usually injected in the buttocks by a physician, although men can learn to self-inject into their thighs. While injections aren’t as convenient as gel, they’re less expensive — about $5 per shot. A longer-acting injection called Nebido, which lasts 10 weeks, is currently under review by the FDA.

    Pellets. Extended-release testosterone pellets are a relatively new option. Six to eight pellets, each the size of a rice grain, are inserted under the skin of the buttocks (a painless procedure using a local anesthetic and done in the doctor’s office). They are gradually absorbed into the body and maintain T levels for three to six months. Pellets are a good option for men who don’t like applying gel daily. Cost is about $500 for a three- to six-month application and is usually covered by insurance.

    Once you begin testosterone therapy, it may take a month or two for T levels to rise to the point where you experience noticeable benefits. As long as they continue to benefit, most men can stay on the therapy for many years.