Do I need Androgen replacement therapy?

In those men with signs or symptoms of androgen deficiency, laboratory confirmation of their hormone levels is required. At present the best way to diagnose androgen deficiency in men is to take a morning blood test for a total testosterone level and LH levels.

The true prevalence of androgen deficiency in older men is unclear. Some men are reluctant to discuss their symptoms with their doctor. Also, how the reference range for testosterone levels for healthy young men applies to older men is not clear.

It is also clear that men with apparently normal or low normal can display symptoms of Androgen deficiency which improves with treatment, presumably due to insensitivity in peripheral tissues.

What are the benefits of androgen replacement therapy?

In men with symptoms of androgen deficiency who have a demonstrable lowering of their testosterone level, testosterone replacement may improve energy levels, reduce fatigue, improve mood and concentration, increase libido, as well as increasing muscle mass, reducing body fat, improve cholesterol levels and increasing bone thickness

What are the side effects of treatment (are there any risks)?

Androgens are the major hormones that control the growth of the prostate gland, and testosterone has been shown to cause the prostate gland and any prostate cancer if present to increase in size. Testosterone replacement therapy should not be started before prostate cancer has been ruled out and treated as appropriate. Men with advanced prostate cancer who undergo medical or surgical castration (removal of the testes to lower the production of testosterone in the body) should not be treated with testosterone. In men with mild symptoms of prostatic enlargement (poor urinary flow) may experience a worsening of symptoms.

Side effects of androgen treatment are uncommon. Mild acne, hair growth, weight gain, breast development (gynaecomastia), male-pattern hair loss and changes in mood (including increased aggression) may be observed and should be managed by the doctor as they happen. When older men start testosterone treatment, they should be advised that they may experience some obstruction of urinary flow and more frequent urination or unfamiliar increases in sex drive. Men who already experience migraine, sleep apnoea or androgen-sensitive epilepsy should be careful of taking testosterone treatments as they may increase these symptoms.

Competitive athletes who are subjected to drug screening in their sporting activities should be advised of the risks of disqualification and prolonged bans if testosterone is prescribed for medical treatment.

In some cases, testosterone replacement treatment can cause an increase in red blood cells (called ‘polycythaemia’) that can lead to problems with blood circulation. This is more likely to be a problem for older men, particularly if they have sleep apnoea. Concerns about liver damage do not apply for any of the forms of testosterone available through in the UK.

How is testosterone therapy given?

Androgen replacement is given in the form of testosterone. Although this can be given by injection or by implant the more usual route is topically to the skin as a patch or gel to rub in. Your doctor would discuss with you the most appropriate dose and route.

What will happen if I start androgen/testosterone therapy?

At your initial visit an assessment will be made of your symptoms by the specialist as well as assessing your blood pressure and a physical examination including prostate assessment will be performed depending on the mans age. Investigations will be arranged that will include a morning blood test for testosterone levels as well as a blood test for the prostate and cholesterol levels, an ultrasound of the prostate will be organised. Your doctor will advise you of the benefits and side effects of treatment as well as the mechanism of follow up to allow you to decide if you wish to proceed with treatment

If it is felt from your symptoms and blood results that you would benefit from testosterone therapy and that there are no contraindications to treatment, a prescription will be arranged, and a repeat appointment made for 3 months. Prior to this follow up visit bloods for testosterone level and prostate hormones will be arranged. These blood tests are repeated prior to your first and second follow up and then at yearly intervals. Follow up visits will be at three monthly intervals for an assessment of your symptoms, checking on any side effects such as reduced urinary flow, skin and hair changes and routine screening before a repeat prescription is given.

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