Testosterone can affect bone density

Dear Dr. Roach: I am a 69-year-old male with very 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? — R.D.

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 prevent metabolic problems, like the loss of bone and possibly harmful effects on blood cholesterol levels.

Returning blood testosterone levels to normal, as your doctor recommends, is the best goal. While the symptoms may get better with only a small dose, it’s possible it’s 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.

Write to Dr. Roach at ToYourGoodHealth @med.cornell.edu.