Patient wants to know if he really needs that much testosterone cream

DEAR DR. ROACH: I am a 69-year-old male with low testosterone levels. My doctor started me on a testosterone cream and increased the frequency of application twice, trying to get my testosterone blood levels to “normal” without success.

He then switched me to injections, increased the amount of the injections, then the frequency, and finally settled on 200 mg, every three weeks.

The problem is that I don’t feel like I need the “normal” levels of testosterone; the very lowest frequency of the cream is sufficient for me. It makes me more ambitious, and I add muscle mass more readily with exercise.

Is there some benefit to the higher “normal” levels of testosterone? Or can I just go with the lower dosage and the lower blood levels that result?

ANSWER: Testosterone replacement is given to men with symptoms of low testosterone who also have low testosterone levels as evidenced by laboratory tests. Common symptoms of low testosterone include low libido and erectile dysfunction, decreased bone mineral density and loss of body hair. The loss of muscle mass and fatigue you mention also may be due to low testosterone, but those symptoms are less specific.

There are two reasons to treat low testosterone: One is to relieve symptoms; the other is to treat or prevent metabolic problems, such as the loss of bone and possibly harmful effects on blood cholesterol levels.

Returning blood testosterone levels to normal, as your doctor recommended, is the best goal. While your symptoms may get better with only a small dose, it’s possible that you are having a placebo response (i.e., you’re getting better because you think you should be getting better, not because of the medication).

I think you will get more benefit from levels in the normal range. Some people have side effects, so your doctor has to find the optimum level for you.

DEAR DR. ROACH: I am a 70-year-old senior in fairly good health, but I am losing my teeth and need many implants. I read that full-mouth X-ray can cause brain cancer. My dentist does not give me a direct answer, and I am afraid. Does the old-fashioned dental X-ray have a lower intensity?

ANSWER: The amount of radiation in a dental X-ray is very, very low. The unit of radiation in this context is the millisievert (mSv), and a regular, old-fashioned bitewing X-ray in your dentist’s office is about 0.005 mSv.

Just walking around in a day, we get about that amount from natural sources.

A full-mouth or panoramic dental X-ray is about 0.01 mSv, but that is still less than a chest X-ray, which is 0.1 mSv. By comparison, a CT scan is equivalent to 4,000 or so dental X-rays.

While it is wise to be concerned about radiation from medical procedures, the radiation in dental X-rays is very small, and the risk of developing brain or other cancer is extremely small.

The thought should not keep you from getting the dental work that is so necessary for the quality of life of many people, including seniors.

I’d advise taking whatever X-ray the dentist thinks is best.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.