As hormones change with age, women experience menopause, and there is growing awareness that men also experience changes. As their testosterone levels drop, older men may turn to testosterone-boosting medication to treat their “Low-T”. Now there is evidence that these testosterone supplements really do help improve the libido and mood of older men, although the improvements may be modest and may have a risk of side effects.
The study comes from Peter J. Snyder, MD, professor of medicine at the University of Pennsylvania, Philadelphia along with colleagues. They published their findings in the New England Journal of Medicine’s February 18th issue. The data comes from three of seven testosterone trials, called the Sexual Function Trial, the Physical Function Trial, and the Vitality Trial. The next four trials will not be published until later this year or next year, but they will look at the effects of testosterone supplementation on anemia, bone density, cognitive function, and heart health.
For decades, doctors have prescribed testosterone gels, patches, and other testosterone supplements to patients with specific health issues, but these prescriptions were rare. However, there has been a growing call in the past fifteen years from aging men, hoping to get a testosterone prescription to help improve their quality of life as their hormones shift. More doctors are prescribing these testosterone supplements to their patients, but there was little evidence of whether the testosterone boost actually helped the men or whether the condition called Low-T even really existed. To fill this gap in knowledge, the Institute of Medicine (IOM) called in 2004 for trials to assess the benefits of testosterone supplements in older men with no specific health issues.
The trials studied 790 men over the age of 65 who had testosterone levels below the average level of a healthy young man. For four months, the men either applied a testosterone gel, specifically Androgel 1%, or a placebo gel, to their skin. In the case of Androgel, the testosterone is meant to gradually absorb into the body through the skin, and from there travel to other parts of the body. Throughout the year, the men in both groups filled in questionnaires to help the researchers see any changes in their sexual function with treatment.
The researchers found that the testosterone gel did seem to improve erectile dysfunction and sexual desire, good news for older men suffering from these issues. However, the improvement seemed to be modest and began to wane nearing the end of the year-long trial. Although the testosterone gel did seem to help men with their sex life, some doctors argue that other specific drugs, such as Viagra (sildenafil), are better for improving sexual function.
Although the treatment offered some hope for older men with low testosterone levels, the study did have its limitations. Its aim was to assess whether testosterone supplementaton could help older men but did not focus on possible side effects. The trial lasted for a year, but there is no information on whether the men involved could face any long-term side effects from their testosterone therapy. Some worry that testosterone could raise the risk of blood clots, heart problems, and prostate cancer. Recent label changes to Androgel and other similar drugs note the possibility of heart attack and stroke in relation to the testosterone therapy.
Another limitation of the study is that it involved only men over the age of 65, while men much younger than that are beginning to ask their doctors for a prescription to treat their Low-T. The study does not determine whether testosterone supplements could help this age range, or if it could help men that are not displaying specific symptoms of low testosterone like the men in the study.
The study is encouraging, showing that testosterone gel can help men regain their sexual desire and function as they age. However, more studies are needed to asses whether the testosterone supplementation can help younger men and whether the benefits outweigh any possible risks of testosterone therapy.
In the year 2000, doctors had written about a million prescriptions for testosterone drugs. By the year 2014, that number had risen to about 6.5 million prescriptions.