With all of the media attention about men and low testosterone (low T), you've probably had your share of men asking about low T and testosterone replacement therapy. You may have even had some of your male patients ask whether bioidentical testosterone replacement therapy is better than the traditional synthetic form.
"Before you prescribe either, it is important to have a conversation with your patient about the benefits and risks of testosterone therapy replacement therapy and to determine whether they truly qualify," says Christopher Deibert, MD, urologist at Nebraska Medicine.
Once men reach their 40s, most will experience a small drop in testosterone production each year after 40. However, only about 15 percent of men will experience a drop in levels that is clinically significant and requires treatment.
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Symptoms that may point toward low T include: low motivation, decreased stamina and energy, low sex drive, depression, hot flashes, loss of muscle mass and mood swings. Men who are obese or have other chronic illnesses are at greater risk for experiencing more significant declines.
A blood test can confirm your suspicions. The bottom of a man's normal total testosterone range is about 300 nanograms per deciliter (ng/dL) and the upper limit is about 800ng/dL, depending on the lab.In general, levels below 300 combined with symptoms are indicators of a testosterone deficiency.
If a patient is not diagnosed and treated properly, testosterone replacement therapy can cause blood clots, stroke, heart or liver toxicity. It can also raise a man's red blood cell count, enlarge his breasts and accelerate prostate growth.
"Men with treated or untreated prostate cancer should not use testosterone therapy unless you have discussed the risks and benefits at length," says Dr. Deibert. "While some of the associations between testosterone replacement and prostate health are being challenged, our group believes that it is safe when provided for the appropriate reasons and monitored carefully," says Dr. Deibert.
Replacement therapies that should not be used include over-the-counter testosterone boosters and bioidentical therapies – neither of which are regulated.
"Some of the advertisements about bioidenticals would lead you to believe that they are more natural, and therefore, safer," says Dr. Deibert. "But that's just simply not the case."
Bioidenticals are termed "natural" because they are derived from plant or animal sources and not created in a lab. However, most of these products still undergo significant processing in a lab to reach the final form, explains Dr. Deibert. Synthetic replacements, on the other hand, are made of chemicals and compounds in a lab that mimic the same structure and chemical composition of hormones produced by the body.
The extracting process involved with bioidenticals can lead to a 20 percent or more variability in the actual testosterone potency. Bioidentical therapies also claim they can customize your dosage based on your unique needs using a saliva test. However, the hormone levels in your saliva don't reflect the levels in your blood.
"Because of this variability and the fact that there's no data showing that they're safer, I would not recommend bioidentical products," says Dr. Deibert. "I typically see eight to 10 patients a week with low testosterone and the majority of these men will have very good symptomatic improvement when treated appropriately with synthetic testosterone replacement therapy."