The People's Perspective on Medicine

New Guidelines for Treating Low Testosterone

Men with low testosterone due to aging may have better sexual function if their doctors prescribe testosterone replacement therapy.
Render illustration of Low Testosterone title on medical documents

Around the turn of the 21st century, drug companies started advertising testosterone on television. They implied that many men suffered from low testosterone and suggested that “low T” could be reversed with testosterone. The idea was that such a treatment in skin patches, topical gels or shots would make middle-aged and older guys feel young again, restoring their strength, energy and sex drive. Presumably, many men also expected it to improve their erections as well.

While some doctors have been enthusiastic, others have had doubts. How well testosterone works for such problems and whether the benefits are outweighed by an increased risk of heart attacks or strokes has been an open question.

Treating Low Testosterone:

There is no doubt that men’s testosterone levels tend to drop with age. However, the decline is more gradual and less dramatic than women’s lower estrogen levels at menopause. The American College of Physicians has just offered guidelines for doctors prescribing testosterone (Annals of Internal Medicine, online Jan. 7, 2020). According to the guidelines, doctors are justified in prescribing testosterone for low libido and erectile difficulties. The evidence is not strong enough to recommend it to treat other problems.

The effectiveness for each patient should be reviewed at least annually. The guidelines recommend intramuscular injections rather than topical formulations to treat low testosterone because injections are significantly less expensive. Fortunately, the reviewers did not find strong evidence of serious adverse effects such as heart attacks.

Learn More:

Injections are not the only way to address low hormone levels. You may wish to listen to our interview with Dr. John La Puma on how to raise levels naturally.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Citations
  • Qaseem A et al, "Testosterone treatment in adult men with age-related low testosterone: A clinical guideline from the American College of Physicians." Annals of Internal Medicine, online Jan. 7, 2020. DOI: 10.7326/M19-0882
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My urologist prescribed clomiphene citrate (tablets) which have raised my testosterone level back to the normal range.

Intramuscular injections, recommended for some men, are not practical for many men. These new guidelines conclude that evidence for long-term efficacy and safety are unknown…still.

For the health-conscious man, lifestyle changes are often a safer and better and immediate choice. Why not raise levels naturally, instead of starting on a drug designed to be prescribed and supplement for life?

I describe the data, and the approach that worked in our studies of men, in my People’s Pharmacy interview: https://www.peoplespharmacy.com/articles/show-975-boosting-testosterone-naturally Enjoy!

About time! This has been an off-limits area for too long.

It’s disappointing that only intramuscular and transdermal approaches were considered. Each has drawbacks.

Intramuscular: Must see a physician every two weeks, can’t self-administer. And levels in the body swing widely. Feel good a day or two after the shot, but can’t perform for the last few days before the next one.

Transdermal: Must take precautions that others do not touch the treated area. This requires wearing a T-shirt during intimacy and when taking grandchildren to the beach.

I wonder why the third approach, pellet implantation every six months, wasn’t included. It has none of the drawbacks listed above. Some practitioners are using Testopel. Local practitioners are are having product made at compounding pharmacies.

Been on T replacement for 7 years, and the results have been amazing. Not only better performance but better outlook on life and just better overall well-being.

Because I had prostate cancer 10 years ago my doctor said that I should NOT take testosterone treatments because testosterone increases the chance of prostate cancer.

Any older person contemplating getting testosterone therapy should be carefully screened for prostate cancer. I have it and was told that more hormone would kick my cancer into high gear.

I am below the bar for testosterone and think that it’s the reason that I am still alive after 20 years of having prostate cancer – that and a Gleason score of 4.

Testosterone pellets injected under the skin every few months are also a good option.

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