Testosterone Replacement Therapy for Male Menopause/Andropause
Testosterone replacement therapy is a treatment option for some men who are experiencing life-changing symptoms associated with male menopause, also known as andropause. Testosterone replacement therapy is also referred to as male hormone replacement therapy, low t therapy, hormone replacement therapy for men, and testosterone replacement. Two questions men often ask are, Can testosterone therapy cause cancer? And, Is hormone replacement therapy safe?
When it comes to hormones, prostate cancer depends on estrogen rather than testosterone, and the fear that taking testosterone will increase a man’s risk of developing prostate cancer has been put to rest. However, it took decades to dispel this myth, which was based originally on a single patient in a study from the 1940s. Among the studies that led to banishment of the testosterone myth was a 2006 report. That research showed that raising testosterone levels in the blood did not raise levels inside the prostate, and thus the prostate was not exposed to excess testosterone. According to Abraham Morgentaler, MD, FACS, author of Testosterone for Life, there is now “good evidence that testosterone therapy is quite safe for the prostate. There is even now a growing concern that low testosterone is a risk for prostate cancer rather than high testosterone.”
About Testosterone Replacement Therapy
Before starting use of testosterone for male menopause, men should undergo a complete general exam. That examination should include a digital rectal examination, PSA test, lipid panel, liver function tests, blood test to determine testosterone levels, and cardiac function tests as well as, in some circumstances, a prostate biopsy. All of these tests should be repeated every 3 to 6 months while men are being treated, because male hormone replacement therapy side effects can be significant. Side effects of testosterone replacement therapy may include an increased tendency to form blood clots, thrombophlebitis (swelling of the veins due to blood clots), and liver toxicity, as well as breast enlargement, urinary tract blockage, sleep apnea, and a rise in PSA levels.
The hormone used in testosterone replacement therapy is available in several forms, including
- Oral. Some oral forms are associated with a high risk of liver toxicity, although newer forms bypass the liver and are less toxic.
- Injectable. Two forms of injectable testosterone are available: testosterone cypionate and testosterone enanthate, and they must be given every 2 to 3 weeks in order to maintain desired hormone levels. Use of injectable testosterone may result in excess hormone being converted to estrogen, which is not desirable.
- Implants. Subcutaneous pellets called Testopel are implanted just under the skin in the buttocks every 3 to 4 months. The procedure can be performed in a doctor’s office and takes 5 minutes. Because testosterone implants provide a constant level of the hormone in the blood, it is a preferred form of testosterone replacement therapy.
- Gels. Topical testosterone gels (Androgel, Axilron, Fortesta, Testim) can be applied daily to the thigh, shoulders, or underarms. Testosterone gels cause minimal side effects and, like implants, are a preferred form of hormone replacement for men.
- Transdermal patches. Use of a transdermal patch for testosterone (Androderm) is highly effective in restoring testosterone levels. Testosterone patches must be applied daily to either the arm, back, or upper buttocks, where they provide continuous 24-hour release of the hormone. The most common side effect is skin irritation.
The goal of testosterone replacement therapy is to have men achieve and maintain a testosterone level that is appropriate for their age and stage of health and without significant side effects. (In fact, testosterone is often considered one of the anti aging hormones.) To make sure this goal is reached and sustained, men need to have their blood tested routinely and their testosterone treatment altered as needed.
Testosterone replacement therapy as male menopause treatment may relieve symptoms of andropause in some men. However, men who have declining levels of other hormones may not get the relief they want since low testosterone may not be their only problem. Male hormone therapy using testosterone replacement is not appropriate for all men who have andropause. Men who have breast cancer or prostate cancer should not take testosterone, and those who any of the following conditions should discuss the benefits and risks with their doctor before starting therapy: liver disease, heart disease, BPH, kidney disease, diabetes, or swelling of the face, hands, feet, or lower legs. Possible risk factors associated with testosterone replacement therapy include infertility, excessive red blood count, water retention, tender breasts, worsening of existing breast cancer in men, liver damage (oral testosterone only), and worsening of prostate symptoms (rare).