To Your Health With Dr. Jim Morrow: Episode 17, Testosterone
How do men and women know if they have low testosterone levels? What are the symptoms of low testosterone levels due to aging, as well as other causes? Dr. Jim Morrow answers these questions and more on this edition of “To Your Health.” “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.
About Morrow Family Medicine and Dr. Jim Morrow
Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be. At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!” Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.
Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”
Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce. He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.
Dr. Morrow’s Show Notes on Testosterone
Physiology of Testosterone and Causes of Hypogonadism in Males
- Testosterone is produced by the testes.
- Decreased production of testosterone by testes in men is categorized as hypogonadism.
- Primary hypogonadism is the failure of the testes to produce sufficient testosterone.
- Testosterone therapy is increasingly common in the United States, and many of these prescriptions are written by primary care physicians.
- There is conflicting evidence on the benefit of male testosterone therapy for age-related declines in testosterone.
- Physicians should not measure testosterone levels unless a patient has signs and symptoms of hypogonadism, such as loss of body hair, sexual dysfunction, hot flashes, or gynecomastia.
- The U.S. Food and Drug Administration clarified in 2015 that prescribing testosterone for low testosterone levels due to aging constitutes off-label use.
- Depressed mood, fatigue, decreased strength, and a decreased sense of vitality are less specific to male hypogonadism.
- Testosterone therapy should be initiated only after two morning total serum testosterone measurements show decreased levels, and all patients should be counseled on the potential risks and benefits before starting therapy.
- Male hypogonadism should be diagnosed only if there are signs or symptoms of hypogonadism and total serum testosterone levels are low on at least two occasions.
- Potential benefits of therapy include
- increased libido,
- improved sexual function,
- improved mood and well-being, and
- increased muscle mass and bone density;
- however, there is little or mixed evidence confirming clinically significant benefits.
- The U.S. Food and Drug Administration warns that testosterone therapy may increase the risk of cardiovascular complications.
- Other possible risks include
- rising prostate-specific antigen levels,
- worsening lower urinary tract symptoms,
- polycythemia, and
- increased risk of venous thromboembolism.
- Patients receiving testosterone therapy should be monitored to ensure testosterone levels rise appropriately, clinical improvement occurs, and no complications develop.
- Testosterone therapy may also be used to treat hypoactive sexual desire disorder in postmenopausal women and to produce physical male sex characteristics in female-to-male transgender patients.
- Other possible risks include
Monitoring of Men on Testosterone Therapy
- Men receiving testosterone therapy should be monitored regularly for adverse effects and to ensure normalization of serum testosterone level.
- Before initiation of testosterone therapy, testing should include:
- a complete blood count to measure hematocrit, and
- a PSA test to detect preexisting prostate cancer.
- Patients should be reevaluated for therapeutic response and adverse effects three to six months after initiation of treatment, including:
- a repeat testosterone measurement,
- complete blood count,
- and PSA test.
- Reevaluation needs to be performed regularly.
- An increase in hematocrit to greater than 54% should lead to
- cessation of treatment,
- lowering of the dose, or
- change to a lower-risk formulation.
- An increase in PSA of greater than 1.4 ng per mL (1.4 mcg per L) over 12 months or an abnormal digital rectal examination result should prompt referral to a urologist.
Testosterone Therapy in Women
- In women, testosterone is produced by the ovaries and adrenal glands, and by conversion of proandrogens in peripheral tissues.
- Levels decrease gradually starting in the 20s or 30s.
- There is no abrupt decrease during menopause, with the exception of surgical menopause.
- Testosterone is also converted to estrogen by aromatases in many tissues; therefore, testosterone is an important source of estrogen in postmenopausal women.
- Testosterone deficiency in women may be associated with problems with sexual function, mood, cognition, and body composition.
- A comprehensive meta-analysis of post-menopausal women found improvement in sexual function with testosterone therapy.
- There was no evidence of improvement in
- body weight or mass, or
- bone density.
- Subsequently, a consensus statement released by several major organizations, including the Endocrine Society and American College of Obstetricians and Gynecologists, supported the use of testosterone therapy for hypoactive sexual desire disorder in postmenopausal women but not for any other indication.
- Of note, there are no FDA-approved products for testosterone therapy in women, and no formulations are readily available in the United States that provide the recommended treatment dosage for women (300 mcg per day), necessitating the use of compounding pharmacies.