Low T: are testosterone treatments safe and effective for most men?

By Nicole Dubowitz



There’s nothing new about the search for the fountain of youth. Men and women have experimented with hormonal therapies to reverse aging since the late nineteenth century: In 1889, neurologist Charles Édouard Brown-Séquard announced that guinea pig and dog testicle injections, and later, surgical implantations, could restore physical and mental health to older men.1

But today, we have advertisements for testosterone topical gels, patches, and underarm roll-ons that make hormone replacement therapy (HRT) look like it should be part of every aging man’s daily routine. In order to qualify for a prescription, men are advised to go to their doctor and test their testosterone levels. If these levels are below “normal” and  “Low-T” symptoms are described, potent hormonal drugs may be yours.

What the ads don’t say is that studies show no agreed-upon “normal”: The range goes from 270 – 1,070 ng/dL for men of all ages. Testosterone (“T”) levels peak in a man’s 20s and decline gradually after age 40, by around 1% every year.2 They vary widely between men and can change by the hour, depending on factors like sleep, exercise, or if your favorite team just won.

Too Much Hype?

Ads note that Low-T symptoms overlap with normal aging, but say the “condition” may be to blame. Online surveys warn that Low-T may cause decreased energy or falling asleep after dinner (guilty!). Moreover, the medical literature fails to establish a consistent relationship between testosterone levels and supposed Low-T symptoms.

Pharmaceutical companies know that women tend to be more conscientious of health matters than men are. So, don’t be surprised if you see advertisements in women’s magazines or during female-geared television shows suggesting that your partner may have “lost that loving feeling” or not be able to perform due to Low-T.3 However, the connection between testosterone levels and libido is inconclusive and testosterone is not a substitute for erectile dysfunction treatments.

Even if T-therapy doesn’t work as advertised, one might wonder what the harm is in trying it. Unfortunately, what we don’t know can hurt us, as demonstrated by HRT for women. In the 1980s and 1990s, women were the target of hormone therapy, which doctors promised would  ease menopause and help prevent heart attacks, strokes, and Alzheimer’s disease. Twenty years later, we learned that hormone supplementation actually increased the risk of all of these ailments, in addition to breast cancer.4

Known Risks

Hormones wreaking havoc is not a novel concept, as naturally occurring excessive hormones are also culprits for cancer in both sexes. Testosterone specifically has been linked to blood clots, the growth of prostate cancer, and worsening congestive heart failure.5 And like HRT for women, T-therapy has been shown to increase cardiovascular risks.6 7 

Transdermal testosterone treatments can affect partners and children of treated men through bodily contact or, anecdotally, even by sharing sheets and towels. Some secondary contact risks are increased body hair and acne in women and children, and enlarged genitalia, increased aggression, and advanced bone age in children.8 Prescription labels always say medicines should only be used by the person they were prescribed for, but it’s much easier to inadvertently share topical medications, which are currently the main form in which testosterone therapy is available.

Testosterone therapy was developed for good reason. It was first FDA-approved for hypogonadism, which is lack of testes or damage to a male’s testes that leads to extremely low natural testosterone production. Low-T drug manufacturers now seek to capitalize on a much wider population, and prescribing rates have tripled since 2001.9 Nevertheless, hormones should not be taken lightly in an effort to stave off aesthetic affects of aging — hormones are powerful drugs that should be used only when we know that benefits outweigh the harms.

  1. Brown-Séquard CE. (1889). “The Effects Produced on Man by Subcutaneous Injections of a Liquid Obtained From The Testicles of Animals.” The Lancet. Available at http://www.usrf.org/news/TRT/Brown-Sequard,%20Lancet,%201889.pdf  
  2. Myers, J. and Meacham, R. “Androgen Replacement Therapy in the Aging Male.” Rev Urol. 2003 Fall; 5(4): 216–22W6.  
  3. Jio, S. “8 Reasons He Doesn’t Want to Have Sex.” Women’s Day. Available at http://www.womansday.com/sex-relationships/sex-tips/8-reasons-he-doesnt-want-to-have-sex-91131. Accessed December 5, 2013.  
  4. Women’s Health Initiative. (2004). “Questions and Answers About the WHI Postmenopausal Hormone Therapy Trials.” Accessed November 25, 2013. Available at http://www.nhlbi.nih.gov/whi/whi_faq.htm.  
  5. Abbott Labs. (2011). Androgel®. FDA/Center for Drug Evaluation and Research. Accessed August 13, 2012.  
  6. Basaria, S., Coviello, A., Travison, T., et al. “Adverse Events Associated with Testosterone Administration.” N Engl J Med 2010; 363:109-122. July 8, 2010. DOI: 10.1056/NEJMoa1000485.  
  7. Vigen, R., O’Donnell, C., Barón, A., et al. “Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels.” JAMA. 2013;310(17):1829-1836. doi:10.1001/jama.2013.280386.  
  8. Landau, E. (2009) “Testosterone gel effects in children spur FDA warning.” CNN Health. Available at http://www.cnn.com/2009/HEALTH/05/07/testosterone.gel.children/.  
  9. O’Connor, A. “Men’s Use of Testosterone on the Rise.” The New York Times “Well” blog. June 3, 2013. Available at http://well.blogs.nytimes.com/2013/06/03/mens-use-of-hormone-on-the-rise/.