Nov. 20, 2006
Testosterone Replacement Therapy May Help Many Older Men
Testosterone replacement therapy may help improve bone mineral density, libido, erectile function, mood and muscle mass in older men with low testosterone levels, according to a University of Iowa researcher.
Moshe Wald, M.D., assistant professor of urology at the University of Iowa Roy J. and Lucille A. Carver College of Medicine, said that while declining testosterone levels in men is a normal part of aging, testosterone replacement therapy should be used for patients in particular need.
"We try to identify those patients who have something beyond age-related testosterone decline," Wald said. "Patients who should be treated may experience certain negative effects because of a decline in testosterone."
As men age, testosterone levels decrease and may begin to decline after age 40. Recent estimates indicate that approximately 13 million men in the United States experience testosterone deficiency.
Wald, who published a review of testosterone replacement studies in the April issue of the Journal of Andrology, said the most common testosterone-related symptoms he treats are problems with erectile or sexual function. Other problems can include decreased general energy levels, mood issues, depression or memory problems.
Testosterone helps maintain certain physiological processes. In addition, lower testosterone is associated with decreased muscle mass and strength, lower bone density, osteoporosis and an increase in central body fat.
Wald noted in his review that men should be treated depending on how low the testosterone level is, as well as the presence of specific clinical symptoms.
"We have to be careful because not every man who has a low testosterone level has problems," Wald said. "We don't want to treat just the testosterone deficiency number, but instead identify those who actually have symptoms due to low testosterone."
Screening patients who are candidates for testosterone replacement therapy ensures that they will not be harmed by the treatment. For example, Wald said testosterone replacement therapy could further increase problems for men who already have prostate cancer or significantly high hemoglobin levels. In such cases, they should not receive the therapy.
"The goal of screening is to make sure we are not putting the patient at further risk," Wald said.
Men on testosterone replacement therapy are monitored to ensure they have not developed adverse affects. Methods of testosterone administration include intramuscular injections, various types of gels and patches, and formulations that are placed on the inside of the cheek.
"We have no established data to support one topical treatment over another," Wald said. "At this time, treatments are very comparable, and the one used depends on each patient's individual preference."
However, Wald said he recommends that patients consider topical preparations because injection treatment does not provide a consistent testosterone level.
"The injection causes testosterone to rise, achieve a peak and then decline," Wald said. "Early in the month the patient feels great, but toward the end he feels poor again because the distribution is not even."
Wald also noted that the long-term clinical effects of testosterone replacement therapy -- including effects on the cardiovascular system, prostate and other target organs -- are uncertain and additional studies are needed.
He said that primary care practitioners can screen patients using blood work and a digital examination of the prostate. Urologists may be more experienced in this screening method, but the practitioner does not have to be a urologist.
"It is important for men who are concerned about testosterone deficiency to be screened," he said. "As long as it is done by a trained health care provider, I am supportive."
Patients should consult with their personal physicians before making any changes to their health care routines.
STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 5224-1178
MEDIA CONTACT: Becky Soglin, 319 335-6660 firstname.lastname@example.org; Writer: Krystal LoewePHOTO: http://www.uihealthcare.com/depts/med/urology/urologymds/wald.html