Testosterone Therapy: Benefits Beyond Sexual Health

Hormone replacement therapy has garnered significant attention over the last several years, with the number of men seeking treatment for low testosterone (hypogonadism) increasing dramatically. Testosterone, the primary sex hormone in men, plays a crucial role in regulating a man's muscle mass, strength, bone health, sex drive and fertility. We have long known the impact of low testosterone on a man's sexual health; however, more and more research has suggested a link between testosterone deficiency and an increased risk for cardiovascular disease and mortality.

Cardiovascular disease is the leading cause of death globally. Approximately one in 20 adults have coronary artery disease, and hundreds of thousands of Americans die every year from heart disease. The exact cause for cardiovascular disease is not so clear-cut, but it is likely a complex interplay between genetic and environmental risk factors.

Unfortunately, we can't change our genetics, but we can change our lifestyle. The most well-known modifiable risk factors include blood pressure, smoking, obesity, diabetes, cholesterol and lack of exercise. However, newer research suggests that testosterone deficiency in men may play a role in one's cardiovascular health. By correcting testosterone deficiency, we may mitigate our risk of heart disease.

Hypogonadism occurs when the body produces insufficient testosterone levels. Low testosterone can occur when the testicles cannot produce testosterone (primary hypogonadism) or when there is a disconnect between our brain and our testicles, such that the testicles never receive the signals to produce testosterone. Hormone imbalances in men occur most often because of age-related decline in our hormone production, similar to the female menopause.

However, there are a variety of other causes ranging from chronic medical conditions such as diabetes, obesity and sleep apnea, to lifestyle causes like stress and anxiety, poor sleep, and alcohol and drug consumption. Distinguishing between the various causes of hormone imbalance is crucial to diagnosing and effectively treating low testosterone. The symptoms of low testosterone are often nonspecific but can include both physical symptoms — including low sex drive, erectile dysfunction, loss of muscle mass, and fatigue — as well as emotional symptoms like irritability, depression and reduced concentration.

Screening for low testosterone requires a simple blood test that is performed in the morning between 7:00am and 10:00am. Typically, testosterone levels are highest in the morning and decline throughout the day, usually reaching their lowest levels in the evening around 7:00pm-8:00pm. Given the variety of factors that can influence testosterone levels, we recommend a confirmatory blood test to ensure an appropriate diagnosis prior to starting any treatment.

There are several methods to help achieve optimum hormone levels with the goal of helping patients to feel back to their best self. A diagnosis of low testosterone can be overwhelming, but a consultation with a urologist can help you decide on the best option for replacement. The most frequently used methods include intramuscular testosterone injections or a daily cream/gel. Injections typically deliver a dose of testosterone directly into the muscle tissue on a weekly or biweekly basis, while gels are applied daily to help maintain steady levels throughout the day. Alternative options include intranasal testosterone or oral pills. There are even long-acting testosterone injections or implantable testosterone pellets that can provide steady testosterone levels for several months.

Historically, the benefits of testosterone replacement therapy have focused on sexual health, but we are now beginning to understand the impact of our hormones on our cardiovascular health. If you have signs or symptoms of low testosterone, a simple conversation with your physician can help establish a diagnosis and develop a treatment plan.