Men, Do You Need Testosterone Supplementation?

Testosterone is one reason men are better than women at push-ups

I’m running across more middle-aged and older men who are taking testosterone supplements. I don’t know if it’s a national trend or simply a Scottsdale, AZ, phenomenon.

The Endocrine Society in 2010 published guidelines regarding testosterone therapy for men who are androgen-deficient. Here are their recommendations on who should be tested for deficiency, and how:

1.1 Diagnosis and evaluation of patients with suspected androgen deficiency

“We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels.

We suggest that clinicians measure serum testosterone level in patients with clinical manifestations shown in Table 1A. We suggest that clinicians also consider measuring serum testosterone level when patients report the less specific symptoms and signs listed in Table 1B.

TABLE 1.
Symptoms and signs suggestive of androgen deficiency in men

A. More specific symptoms and signs
Incomplete or delayed sexual development, eunuchoidism
Reduced sexual desire (libido) and activity
Decreased spontaneous erections
Breast discomfort, gynecomastia
Loss of body (axillary and pubic) hair, reduced shaving
Very small (especially < 5ml) or shrinking testes

Inability to father children, low or zero sperm count
Height loss, low trauma fracture, low bone mineral density
Hot flushes, sweats

B. Other less specific symptoms and signs
Decreased energy, motivation, initiative, and self-confidence
Feeling sad or blue, depressed mood, dysthymia
Poor concentration and memory
Sleep disturbance, increased sleepiness
Mild anemia (normochromic, normocytic, in the female range)
Reduced muscle bulk and strength
Increased body fat, body mass index
Diminished physical or work performance

We suggest the measurement of morning total testosterone level by a reliable assay as the initial diagnostic test.

We recommend confirmation of the diagnosis by repeating measurement of total testosterone.

We suggest measurement of free or bioavailable testosterone level, using an accurate and reliable assay, in some men in whom total testosterone concentrations are near the lower limit of the normal range and in whom alterations of SHBG are suspected.

We suggest that an evaluation of androgen deficiency should not be made during an acute or subacute illness.”

Harriet Hall thinks testosterone is being over-prescribed.