Transcript of Video
Hi, I’m Dr. Michael Graham. I’m one of the Urologists here at Northwoods Urology of Texas. I’m here today to speak about testosterone therapy. Well, in a group of men, as we age, the testosterone levels can drop just as a part of the natural aging process for a lot of men, not all men get it, but certainly a large fraction of men do.
As the testosterone levels drop, men can notice changes, as far as mood changes, difficulty maintaining muscle mass, difficulty keeping off excess body fat. It can have a number of effects on energy, sex drive, or libido, and we’re able to supplement testosterone in men who are having problems with symptoms related to low testosterone. And we typically do that in our practice either with topical testosterone gels or testosterone injections or implantable testosterone pellets. There is no cutoff age at which point you’re too old or too young to have problems with testosterone.
We’ve seen men as young as their early 20s with low testosterone, and again, we’ve treated men in their 80s as well. It really comes down to whether a given patient is having bothersome symptoms, so we don’t typically randomly check testosterone levels just out of curiosity, usually it’s driven by symptoms. The amount of side effects with testosterone therapy is fairly minimal. We do have to do some monitoring. We start with a best guess of dosage for the patients, and that’s true whether they get gel, whether they get injections, or whether they get pellets. And then we confirm with follow-up blood work, as far as whether we’re hitting our target testosterone levels, as well as interview the patients again to see if their symptoms are improving.
We do have to monitor red blood count just to make sure it doesn’t go too high. If the red blood count rises excessively high in response to testosterone therapy, we can send those patients to the blood bank for phlebotomy, or to withdraw some blood to bring the blood count back to normal. We do monitor the risk of prostate cancer. Testosterone therapy does not cause prostate cancer, and it does not cause urinary symptoms, but the prostate is part of the male reproductive tract, so it does respond to male hormones.
So if something like a small prostate cancer was already present, it could grow in the presence of testosterone, whether that comes from the testicles or whether it comes from a testosterone supplement. So it can continue to monitor that risk of prostate cancer. There are some advisories from the FDA as far as whether testosterone supplements in any form contribute to an increased risk of clotting in the body, that could be clots in the legs, clots in the hearts, clots in the lungs. The FDA has issued an advisory saying that that is an area of ongoing investigation. In the urology literature, we have a number of well documented studies that don’t show any type of clotting risk associated with testosterone supplements.
Unfortunately, those studies are fairly small in number, so that’s one of the reasons that studies are ongoing. And then, there were a few studies that were brought to the attention of the FDA that raised some concerns about clotting events in the body. Those studies were fairly large, but they were fairly poorly done, sometimes involving studies where we didn’t even know whether the patients got the testosterone that was prescribed. We knew they were prescribed testosterone. We didn’t know what dosage they were given, if they actually took it.
So, long and the short of it is, the FDA has issued some advisories saying, “You oughta be aware “that there may or may not be an increased risk “of clotting events in the body with testosterone therapy.” And that’s something we’ll interview patients about as well with their follow-up visits. As Urologists here at Northwoods Urology of Texas, we are committed to a broad range of testosterone replacement options, not just one type or another, we’re comprehensive in our approach.
So if you’re having symptoms that make you suspicious that you might have a low testosterone level, please check our website or give us a call, and we can set up a consultation in the office or provide information through the website.