As men age from 50 to 70, their testosterone levels drop more than 40 percent, causing them to become fatter, and less sexual, muscular and assertive and have smaller, weaker bones (7,11). Twenty percent of men aged 60-80 years have testosterone levels below the lower limit of normal. Giving testosterone to normal men over 65 years of age causes them to lose fat, principally in the arms and legs, and increase muscle and bone size, principally in the trunk (1,12). Testosterone is an effective treatment for depression in older men (13). A study in the American Journal of Psychiatry shows that men who are mildly depressed have much lower levels of the male hormone, testosterone, than men who are severely crippled by depression and men who have no depression at all (1a).
Men with low blood testosterone levels are at high risk for heart attacks (3, 2), even though testosterone pills lower blood levels of the good HDL cholesterol and increase a man's chances of getting a heart attack. Men with the highest testosterone levels have the lowest blood insulin levels which prevents heart attacks (3). Insulin is necessary to keep blood sugar levels from rising too high, but it also can increase your chances of getting a heart attack by causing arteries to constrict, and making you fat by causing hunger and forcing your liver to make extra fat from the extra calories that you consume.
Testosterone injections can make older men with low blood levels of testosterone more interested in making love (4,5,6). The only reported significant side effect is an increase in the concentration of red blood cells that could cause clots. Two major theoretical concerns about prescribing testosterone to older men are that they may cause a heart attack or spread an existing prostate cancer. However, only testosterone pills have been shown to lower blood levels of the good HDL cholesterol and cause heart attacks. Testosterone injections and skin patches do not (8,9,12).
Testosterone gels such as Androgel or Testim are highly effective. Since they are absorbed through the skin, they bypass the liver and have not been reported to lower the good HDL cholesterol that helps prevent heart attacks.
Studies from Chicago Medical School (10) showed that men 60 to 75 years of age who take very low doses of the male hormone, testosterone, (25 to 50 mg) weekly for two years have lower blood cholesterol levels, less body fat and greater muscle strength. Their prostates did not enlarge and their PSA blood test did not rise. More research is needed, but older men who take testosterone, should take injections or patches, rather than pills, and have their prostates checked by physical exam, sonogram and a blood test called free PSA.
Side effects of testosterone include androgen-sensitive epilepsy, migraine, sleep apnea, polycythemia or fluid overload. Use of testosterone is banned in many sports competitions.
1a)American Journal of Psychiatry March, 2002.
1) PJ Snyder, H Peachey, P Hannoush, JA Berlin, L Loh, DA Lenrow, JH Holmes, A Dlewati, J Santanna, CJ Rosen, BL Strom. Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. Journal of Clinical Endocrinology and Metabolism, 1999, Vol 84, Iss 8, pp 2647-2653.
2) SP Zhao, XP Li. The association of low plasma testosterone level with coronary artery disease in Chinese men. International Journal of Cardiology 63: 2(JAN 31 1998):161-164.
3) D Simon, MA Charles, K Nahoul, G Orssaud, J Kremski, V Hully, E Joubert, L Papoz, E Eschwege. Association between plasma total testosterone and cardiovascular risk factors in healthy adult men: The telecom study. Journal of Clinical Endocrinology and Metabolism 82:2(FEB 1997):682-685. Some doctors give the low dose injections of 25 mg of testosterone cypionate or enanthate every 2 weeks. The treatment for men who have almost no testosterone is 10 times that dosage. A normal male produces the equivalent of 100 mg of testosterone (enanthate) each week.
4) RR Hajjar, FE Kaiser, JE Morley. Outcomes of long-term testosterone replacement in older hypogonadal males: A retrospective analysis. Journal of Clinical Endocrinology and Metabolism. 82: 11 (NOV1997):3793-3796. Address JE Morley, St Louis Univ, Hlth Sci Ctr, Dept Internal Med, Div Geriatr Med, 1402 S Grand Blvd, Room M238, St Louis, MO 63104 USA.
5) R Sih, JE Morley, FE Kaiser, HM Perry, P Patrick, C Ross. Testosterone replacement in older hypogonadal men: A 12-month randomized controlled trial. Journal of Clinical Endocrinology and Metabolism 82: 6(JUN 1997):1661-1667.
6) FCW Wu, TMM Farley, A Peregoudov, GMH Waites, GY Zhang, GZ Li, EM Wallace, HWG Baker, XH Wang, JC Soufir, CA Paulsen, C Gottlieb, DJ Handelsman, I Hutaniemi. Effects of testosterone enanthate in normal men: Experience from a multicenter contraceptive efficacy study. Fertility and Sterility 65: 3 (MAR 1996):626-636.
7) DA Schow, B Redmon, JL Pryor. Male menopause – How to define it, how to treat it. Postgraduate Medicine 101: 3 (MAR 1997):62.
8) BS Uyanik, Z Ari, B Gumus, R Yigitoglu, T Arslan. Beneficial effects of testosterone undecanoate on the lipoprotein profiles in healthy elderly men – A placebo controlled study. Japanese Heart Journal 38: 1 (JAN 1997):73-82.
9) Tenover JS. Androgen administration to aging men. Clinical Andrology 1994(Dec);23(4):877-891. 7) Annual Endocrine Society Meetings Washington, D.C. June, 1995.
10) JE Morley, FE Kaiser, R Sih, R Hajjar, HM Perry. Testosterone and frailty. Clinics in Geriatric Medicine 13: 4 (NOV 1997):685.
11) KCB Tan, SWM Shiu, RWC Pang, AWC Kung. Effects of testosterone replacement on HDL subfractions and apolipoprotein A-I containing lipoproteins. Clinical Endocrinology 48: 2 (FEB 1998):187-194.
12)BC Lund, KA BeverStille, P. Perry.Testosterone and andropause: The feasibility of testosterone replacement therapy in elderly men. Pharmacotherapy, 1999, Vol 19, Iss 8, pp 951-956.
13)S Basaria, AS Dobs.Risks versus benefits of testosterone therapy in elderly men.Drugs & Aging, 1999, Vol 15, Iss 2, pp 131-142.
14) AJ Conway, DJ Handelsman, DW Lording, B Stuckey, JD Zajac. Use, misuse and abuse of androgens – The Endocrine Society of Australia consensus guidelines for androgen prescribing. Medical Journal of Australia, 2000, Vol 172, Iss 5, pp 220-224. Address: Zajac JD, Univ Melbourne, Royal Melbourne Hosp, Dept Med, Parkville, Vic 3050, AUSTRALIA