Low Testosterone Therapy: Is It For You?

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Low energy, fatigue, slack muscle tone, not sleeping well – these symptoms are common to many aging men. Could the cause be low testosterone? Many younger men looking for answers to similar problems are seeking treatment for Low T as well.

Learn about the risks and benefits of testosterone therapy from University Hospitals urologist Aram Loeb, MD, and why it’s important to see a urologist for this treatment.

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Podcast Transcript

 

Pete Kenworthy

Hi everyone. I'm Pete Kenworthy.

Macie Jepson

And I’m Macie Jepson. And this is Healthy@UH. Today we’re breaking down low testosterone or low T. We're seeing this mentioned a lot these days in ads. It's a natural occurrence in men, but something that men don't always want to accept for sure.

Pete Kenworthy

And the questions we have today, a number of things. What is testosterone's role in a man's body? Why do you need it? And then if a man has low testosterone, is he automatically a candidate for treatment? And what are the risks and benefits of that?

Macie Jepson

But as we always say, we are not the experts. So, we invited Dr. Aram Loeb, urologist specializing in male sexual function at University Hospitals to break this down for us. First, Doctor, thank you for being with us. What role does testosterone play in the body? What happens when men begin to experience low levels?

Dr. Aram Loeb

First of all, thank you for having me. So, testosterone is a hormone in the body that plays a role in all sorts of critical functions. It's involved in bone health, cardiovascular health. It's also involved in their energy levels, their libido, their erections. And that's often what brings them into the clinic to have it addressed.

Pete Kenworthy

Why do men know that they have low testosterone? And my thought first would be this is an older man thing, but it's not just older men who are seeking treatment for this.

Dr. Aram Loeb

No, it's definitely not just older men. A lot of the things that do present are just kind of that edge, that drive. Some guys say, you know, in the morning I wake up as just can't feel like I can, I can make it to the gym. It's harder to get things done. I'm not as focused at, at work. And this can be multifactorial. There's so many things in guys' lives now that, that can cause that, you know, stress at work at home, not sleeping well and maybe their eating habits aren't as good. They're overweight. But testosterone can play a role in that. So, guys do come in and kind of seek that and see is this potentially a source of these issues that I'm having.

Macie Jepson

So, Doctor, I'm guessing then that you need to have a good assessment first to make sure that there aren't some other issues. Like, hey, let's drop 20 pounds or let's start exercising. Let's make sure that you're healthy. But then when you get to the point, OK, you could use a boost of testosterone. Is this therapy always a good idea?

Dr. Aram Loeb

Nothing is ever, you know, always a good idea. So, coming in, having the discussion with your physician or if your physician isn’t comfortable having that discussion, you come and see a urologist who specializes in this area and talk about the risks and benefits of therapy. There are screening tests that we like to do to, to monitor and to make sure that you do have a true low testosterone level. And there are some other lab tests that we’d like to check that we will monitor when you're on therapy. So, having that discussion, understanding the risks and benefits will really lead to a better outcome.

Pete Kenworthy

So, you're talking about risks and benefits. I’d like to dive into that a little bit further. What are those? What are the, what are the, you know, give me the top three benefits, top three risks of this treatment.

Dr. Aram Loeb

So, beginning with the risks, every guy I talk to about testosterone, on that medication, there's a black box warning that talks about the risk of cardiovascular disease, which includes stroke, blood clots, pulmonary embolus.

So, a lot of these studies are based upon older data, flawed data. And new recommendations have come out that’s actually show there's some cardiovascular benefit to being on testosterone therapy. It improves your cognition, can increase your energy levels, can improve your erections. Those are some of the benefits I talk to guys about.

Macie Jepson

Women who are considering hormonal replacement treatments are concerned about increased risks of breast cancer. Any cancer risks for men as well?

Dr. Aram Loeb

So, testosterone has always been linked to prostate cancer. The only urologist who ever won the Nobel Prize actually found this link, but it was looking at patients who have metastatic prostate cancer. And we find that we eliminate their testosterone and their cancer does get better. But guys who have normal testosterone levels or low normal testosterone levels and taking them to a normal level does not increase their risk of prostate cancer. It doesn't make their prostate cancer more aggressive. It doesn't worsen any urinary symptoms. And it's actually been shown that it may benefit some of those symptoms.

Pete Kenworthy

There is a risk for younger men, especially men maybe considering having a family in the future, right? For testosterone treatment. Talk a little bit about that.

Dr. Aram Loeb

Yeah. So, when you take testosterone…we call it exogenous testosterone… what it tells your body is that we're good. You're doing a good job producing the testosterone. So, most of your testosterone is produced in your testicles. And the other job that the testicles do is produce sperm. So, when the body says, oh no, we're good, it's going to shut off your own production of testosterone, but also your sperm production. So, I do caution young guys who are on testosterone therapy that this can make you infertile. It can be permanent. Oftentimes within a year you will get reproduction of sperm, but something to be aware of if you're out there and on testosterone.

Macie Jepson

I'm curious to know why young guys would need testosterone.

Dr. Aram Loeb

Yeah. So, even young guys can have low testosterone. They can have these symptoms of low testosterone, and, you know, laboratory data confirming that they have low testosterone. It may be something they, they've had their whole life, maybe born with or something that has been acquired as, as they've aged.

Pete Kenworthy

There are ads on that you hear on the radio that encourage men to come in. Hey, come on in here. We'll, we'll guarantee we'll make you better with your, your low testosterone issues. Tell me about those, those shot clinics, whatever they're called. Are they safe? Do they deliver results?

Dr. Aram Loeb

I mean, I would caution against guys reaching out to those. You know, you can come in, see a physician, a urologist. Insurance provides this benefit, and we'd be happy to discuss with you all the same type of things that you can have at these clinics. But we can do it in a controlled setting, properly monitor you. I see a lot of patients who have been to these clinics. They've spent a lot of money. This is a lot of those young guys who are on testosterone and now they're having issues with their fertility or they've had other issues and really wish they would have come to us first and we could have, you know, done this in the proper way.

Macie Jepson

So, Doctor, if someone listening to this says, this might be me, and they make an appointment. What can they expect?

Dr. Aram Loeb

First consultation, I'm going to talk to these guys about what testosterone can really do for them. Is it going to be that silver bullet that cures all of their ailments? No. But we're going to talk about improving their overall health. We're going to exercise, weight loss, sleeping well. Obstructive sleep apnea is a very common cause of low testosterone. So, if they have those issues, I'm going to refer them to a sleep specialist. Maybe they need to be on a CPAP machine.

Once we go from there, we're going to get some blood tests. I like to check early morning testosterone levels ‘cause that's when those levels spike and then they kind of fall off throughout the day. If you have two confirmed low testosterone levels, we will talk about therapy options for you.

There's a lot of different ways that we can administer testosterone these days. There's gels, which are kind of almost like a deodorant type of application you can apply to the upper arm. These work well for guys, you know, but it is a once-a-day type of application. You need to be careful if you're around young kids or women that you could transfer this. So, you've got to wash your hands really well, wear shirts that cover your upper arms.

Another option are injections that you can give yourself. They give you a nice spike of testosterone, and it kind of wanes off over the next week or two. And then you re-administer the injections.

There's also pellets that we can place in the office in a small office procedure that can last about four to six months. So, there's a lot of different options that are out there. And in the properly monitored setting, guys got very good results.

Pete Kenworthy

All right. It sounds perfect. We’re going to wrap it up here. How about a summary of what we talked about today?

Dr. Aram Loeb

Yeah, so I think here at University Hospitals, the Urology Institute, we are really looking to provide comprehensive men's care. A lot of times a urologist is kind of the gatekeeper of men's health. And we take this very seriously. We're happy to see you to discuss these issues. We have clinics all throughout the metro Cleveland area with our physicians that are happy to, you know, discuss with you testosterone therapy, really go through the risks and benefits, properly monitor you and do this in the correct setting.

Macie Jepson

Dr. Aram Loeb, thank you…

Dr. Aram Loeb

Thank you so much.

Macie Jepson

… for your insight. For more health news, advice from our medical experts and Healthy@UH podcasts, go to UHHospitals.org/blog.