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Testosterone replacement therapy, also known as topping up, helps individuals by replenishing their testosterone levels.

Topping Up Testosterone?

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The Testosterone Drop

Testosterone levels decline amongst men over a certain age. Exactly when depends on the individual and also how we measure it, but the age of 45 is a commonly-given waypoint for the start of this decline.

(the actual start is usually more like 20, but it’s a very small decline then, and speeds up a couple of decades later)

This has been called “the male menopause”, or “the andropause”.

Both terms are a little misleading, but for lack of a better term, “andropause” is perhaps not terrible.

Why “the male menopause” is misleading:

To call it “the male menopause” suggests that this is when men’s menstruation stops. Which for cis men at the very least, is simply not a thing they ever had in the first place, to stop (and for trans men it’s complicated, depending on age, hormones, surgeries, etc).

Why “the andropause” is misleading:

It’s not a pause, and unlike the menopause, it’s not even a stop. It’s just a decline. It’s more of an andro-pitter-patter-puttering-petering-out.

Is there a better clinical term?

Objectively, there is “late-onset hypogonadism” but that is unlikely to be taken up for cultural reasons—people stigmatize what they see as a loss of virility.

Terms aside, what are the symptoms?

❝Andropause or late-onset hypogonadism is a common disorder which increases in prevalence with advancing age. Diagnosis of late-onset of hypogonadism is based on presence of symptoms suggestive of testosterone deficiency – prominent among them are sexual symptoms like…❞

(Read more)

…and there we’d like to continue the quotation, but if we list the symptoms here, it won’t get past a lot of filters because of the words used. So instead, please feel free to click through:

Source: Andropause: Current concepts

Can it be safely ignored?

If you don’t mind the sexual symptoms, then mostly, yes!

However, there are a few symptoms we can mention here that are not so subjective in their potential for harm:

  • Depression
  • Loss of muscle mass
  • Increased body fat

Depression kills, so this does need to be taken seriously. See also:

The Mental Health First-Aid That You’ll Hopefully Never Need

(the above is a guide to managing depression, in yourself or a loved one)

Loss of muscle mass means being less robust against knocks and falls later in life

Loss of muscle mass also means weaker bones (because the body won’t make bones stronger than it thinks they need to be, so bone will follow muscle in this regard—in either direction)

See also:

Increased body fat means increased risk of diabetes and heart disease, as a general rule of thumb, amongst other problems.

Will testosterone therapy help?

That’s something to discuss with your endocrinologist, but for most men whose testosterone levels are lower than is ideal for them, then yes, taking testosterone to bring them [back] to “normal” levels can make you happier and healthier (though it’s certainly not a cure-all).

See for example:

Testosterone Therapy Improves […] and […] in Hypogonadal Men

(Sorry, we’re not trying to be clickbaity, there are just some words we can’t use without encountering software problems)

Here’s a more comprehensive study that looked at 790 men aged 65 or older, with testosterone levels below a certain level. It looked at the things we can’t mention here, as well as physical function and general vitality:

❝The increase in testosterone levels was associated with significantly increased […] activity, as assessed by the Psychosexual Daily Questionnaire (P<0.001), as well as significantly increased […] desire and […] function.

The percentage of men who had an increase of at least 50 m in the 6-minute walking distance did not differ significantly between the two study groups in the Physical Function Trial but did differ significantly when men in all three trials were included (20.5% of men who received testosterone vs. 12.6% of men who received placebo, P=0.003).

Testosterone had no significant benefit with respect to vitality, as assessed by the Functional Assessment of Chronic Illness Therapy–Fatigue scale, but men who received testosterone reported slightly better mood and lower severity of depressive symptoms than those who received placebo❞

Source: Effects of Testosterone Treatment in Older Men

We strongly recommend, by the way, when a topic is of interest to you to read the paper itself, because even the extract above contains some subjectivity, for example what is “slightly better”, and what is “no significant benefit”.

That “slightly better mood and lower severity of depressive symptoms”, for example, has a P value of 0.004 in their data, which is an order of magnitude more significant than the usual baseline for significance (P<0.05).

And furthermore, that “no significant benefit with respect to vitality” is only looking at either the primary outcome aggregated goal or the secondary FACIT score whose secondary outcome had a P value of 0.06, which just missed the cut-off for significance, and neglects to mention that all the other secondary outcome metrics for men involved in the vitality trial were very significant (ranging from P=0.04 to P=0.001)

Click here to see the results table for the vitality trial

Will it turn me into a musclebound angry ragey ‘roidmonster?

Were you that kind of person before your testosterone levels declined? If not, then no.

Testosterone therapy seeks only to return your testosterone levels to where they were, and this is done through careful monitoring and adjustment. It’d take a lot more than (responsible) endocrinologist-guided hormonal therapy to turn you into Marvel’s “Wolverine”.

Is testosterone therapy safe?

A question to take to your endocrinologist because everyone’s physiology is different, but a lot of studies do support its general safety for most people who are prescribed it.

As with anything, there are risks to be aware of, though. Perhaps the most critical risk is prostate cancer, and…

❝In a large meta-analysis of 18 prospective studies that included over 3500 men, there was no association between serum androgen levels and the risk of prostate cancer development

For men with untreated prostate cancer on active surveillance, TRT remains controversial. However, several studies have shown that TRT is not associated with progression of prostate cancer as evidenced by either PSA progression or gleason grade upstaging on repeat biopsy.

Men on TRT should have frequent PSA monitoring; any major change in PSA (>1 ng/mL) within the first 3-6 months may reflect the presence of a pre-existing cancer and warrants cessation of therapy❞

Those are some select extracts, but any of this may apply to you or your loved one, we recommend to read in full about this and other risks:

Risks of testosterone replacement therapy in men

See also: Prostate Health: What You Should Know

Beyond that… If you are prone to baldness, then taking testosterone will increase that tendency. If that’s a problem for you, then it’s something to know about. There are other things you can take/use for that in turn, so maybe we’ll do a feature on those one of these days!

For now, take care!

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