Is Testosterone Replacement Therapy for Real?

In my General Practise, just outside of Dublin Ireland, I now have thirty-eight men on Testosterone Replacement Therapy or TRT as it is now becoming known. The list grows longer every month. Some of these men have been on this therapy for several years now and very few of them would want to discontinue it without some compelling reasons for their doing so. They range in age from fifty to seventy-five years of age. I have been looking at their records and in order of frequency, their pre-treatment symptoms were:

• Loss or reduction of libido or sex drive.
• Lethargy or lack of zest for life.
• Erectile dysfunction.
• Increased visceral fat.
• Decreased muscle mass.
• Decreased strength.
• Increased tendency to fall asleep during the day.

Testosterone replacement therapy has changed quite significantly in the last ten years. Ten years ago, before a man was considered suitable for TRT, he was required to undergo a battery of hormonal assays. These included exotic names like free and bonded testosterone, sex hormone binding globulin, serum prolactin and luteinizing hormone.

These tests were not only very expensive they were also unhelpful. Blood levels of testosterone, free or bonded, are notoriously unreliable and difficult to interpret. Recently I have abandoned their use altogether and replaced them with a more pragmatic approach of measuring benefit, if any, before and after treatment begins. This can easily be done using a self-assessment questionnaire called the ADAM test. If you are wondering whether you might benefit from a little TRT then score yourself on the ADAM test and you will get a very good idea.

In this short piece, I am not giving references to published scientific papers. If you are interested in the science supporting the value of TRT then I would urge you to spend some time at www.andropause.org.uk. Work is ongoing and very exciting but what is now emerging is that testosterone, as an oxidative stress reducer, may have a role to play in the prevention or management of dementias including Alzheimer’s Disease and senile dementia. It is also becoming apparent that TRT has a role to play in the management on Type 2 diabetes, generalised arteriosclerosis, Metabolic Syndrome and coronary artery disease.

Another recently introduced improvement in the management of androgen deficiency was the introduction of a sustained release intramuscular injection called Nebido. Administered by a doctor every ten weeks this preparation is a big improvement on previous gels, implants, patches and erratic injections. I usually recommend gel for the first month to see if it is beneficial and then move on to Nebido if the client is impressed.

Finally, just a word or two of caution. Firstly, do not have exaggerated expectations of what testosterone replacement will do for you. In the main, its effects are subtle and almost subliminal. There will be a slight increase in libido, a slight increase in morning erections and a slight diminution of erectile dysfunction. However, noting dramatic will happen and I always make a point of explaining this to men before they start.

The last word has to be about Prostate Specific Antigen or PSA as it is now known. Before you can be considered as a candidate for testosterone replacement therapy you will need to have this checked out. If your PSA is raised then the reason for that raise must first be ascertained. However, do not forget that not all raised PSA points to prostate cancer, so do not be alarmed. I will return to this another day.