What Is Hormone Replacement Therapy for Men?

Hormone replacement therapy is a medical treatment used to alleviate the effects of low testosterone in men. Patients who need it experience a range of symptoms or might suffer from injury or disease causing low natural testosterone. After checking testosterone levels and ruling out other conditions, doctors can prescribe a variety of forms of testosterone. Patients who suffer from certain conditions should avoid therapy as it results in a number of side effects.

What Is It?

• Hormone replacement therapy is a medical treatment regimen used to alleviate the effects of low testosterone production in men as they age. In human males, the production of testosterone peaks between the ages of 18 to 25 and begins to decline after age 25 at a rate of about two percent per year. This can cause a number of symptoms including a decrease in muscle mass and bone density, loss of energy, decreased libido, and a decline in overall mental health and well-being.

  To lessen or reverse these conditions and enhance quality of life, doctors have prescribed testosterone to supplement or replace the body's natural production of testosterone.

Symptoms

• Some of the symptoms associated with testosterone deficiency include lower libido, difficulty concentrating or remembering, depression, thinning skin, erectile dysfunction, tiredness, and a loss of muscle and increase in body fat. Other changes can include changes in how the body processes cholesterol, lowered red blood cell count (mild anemia) and osteoporosis.

Who Needs It?

• Men over 30 who notice any of the above symptoms can consult their doctor about receiving testosterone replacement therapy. Additional causes of testosterone deficiency include testicular injury or infection, chemotherapy, pituitary or hypothalamic injury or trauma, congenital conditions that cause hypogonadism (low sperm count), kidney failure, sarcoidosis (a disease that inflames the lung and organ tissue), and cirrhosis of the liver.

Diagnosis

• Doctors prescribe hormone replacement therapy after a medical exam, taking a full medical and medication history, and testing blood-serum levels of testosterone. If the testosterone level is low and coincides with reduced libido, the doctor will also measure serum prolactin and levels of luteinizing hormone (to check for pituitary dysfunction). Hormone therapy is indicated when serum testosterone is low and luteinizing hormone (a precursor to testosterone production) is high.

  A doctor might also ask questions about ability to maintain erections, frequency of erections (including nocturnal erections), and frequency of sexual activity and urges to have sexual activity.

  A doctor might also check for changes in body composition, possibly including a test of bone density.

Treatment

• Patients prescribed hormone replacement therapy can receive testosterone via a number of delivery methods, including intramuscular injections, transdermal patches, creams, and sprays applied to the skin, and oral testosterone taken as pills. Dosages vary depending on mode of treatment; typical injections, for example, range from 50 to 400 mg, every two or three weeks.

Contraindications

• Excess testosterone can enlarge the prostates of older men and is not recommended for men who suffer from prostate cancer or may be prone to prostate cancer. As testosterone can affect liver levels and blood serum cholesterol, patients should consult their doctor if suffering from liver disease, coronary disease, chest pain, high cholesterol or have had heart failure in the past.

  Testosterone can also affect blood sugar levels and diabetics should consult a doctor first and monitor blood sugar closely while undergoing treatment.

Side Effects

• Serious side effects of testosterone include high blood pressure, the reduction of good cholesterol levels, jaundice, and heart and liver disease. Those receiving hormone replacement therapy might also experience acne, greasy skin and edema (swelling of the feet and ankles).

  Testosterone can also further enhance male characteristics, deepening the voice and producing excess facial and body hair. Also, because excess testosterone can convert to estrogen, males are at risk for gynecomastia (male breast enlargement). This condition is not always reversible and may require surgery to correct.