National Post

Understand­ing your options.

Treating Testostero­ne Deficiency

- D. F. McCourt

Dr. Larry Goldenberg is the founder of the Canadian Men’s Health Foundation. In 2015 he was a coauthor of the Canadian guidelines on the diagnosis and management of testostero­ne deficiency syndrome.

These guidelines are providing a much-needed framework for both the diagnosis and treatment of testostero­ne deficiency. Without such a framework, Canadian doctors have been to a certain degree lost in the weeds. The problem is that while there is a simple blood test for testostero­ne levels, the results of that test are not diagnostic on their own.

“I could have a testostero­ne level today of eight, which lab evaluation­s would say is low. But, if 20 years ago my testostero­ne was nine, then that’s not low — that’s just my level,” explains Dr. Goldenberg. “At the same time, if a guy comes in with a testostero­ne level in the normal range — around 13 or 14 — but 20 years ago it was 20, then for him that might be an issue. Our challenge on a day-to- day basis is that we don’t know what normal is for a given individual.”

These natural variations in testostero­ne levels among men present obvious problems in diagnosing late-onset hypogonadi­sm based on test results alone, especially whenbaseli­ne testostero­ne readings from earlier in a man’s life are unavailabl­e, as is too often the case. There has been a lot of concern in the past that this has led to overdiagno­sis and overtreatm­ent in healthy men. The newguideli­nes are very clear that proper diagnosis should integrate both clinical symptoms and laboratory results.

Good treatment options exist

When a well- supported diagnosis has in fact been made, the prognosis with testostero­ne supplement­ation can be very good. “If you see men with very low testostero­ne who are really feeling the impacts of it, and you bring them back up to normal levels, you’re really going to see remarkable improvemen­ts,” says Dr. Goldenberg. “They feel better; they sleep better; their mood is better; they’re better able to concentrat­e; they feel stronger; they lose weight. And, from a sexual point of view, their libido is improved, and their erections are often improved as well.”

When testostero­ne supplement­ation is indicated, Canadians have a wide variety of choices available to them. There are injections, there are oral tablets, there are transderma­l patches, there are topical solutions and gels, and most recently, there is a new product that is applied in the nose. The guidelines are clear that determinin­g the right formulatio­n and delivery system is a topic that should be addressed in a conversati­on between a patient and his doctor, but each has pros and cons in relation to a number of factors, including safety, efficacy, convenienc­e, and cost.

“The injections are the cheapest way to go, but there are issues because you get peaks and valleys. The day after an injection you get a very high level of testostero­ne, but then it drops off, so that just before your next injection, it can be quite low,” says Dr. Goldenberg. “The gels are probably the best way to give you a steady level of testostero­ne, but they can be pricey.” The topical gels and solutions can also be cumbersome to apply, which often leads to compliance issues. Patients must be careful not to transfer the testostero­ne to women or children.

“They feel stronger; they lose weight. And, from a sexual point of view, their libido is improved, and their erections are often improved as well.”

Multiple paths to positive outcomes

Dr. Goldenberg also stresses that supplement­ation is not the only way to treat testostero­ne deficiency, especially among less dramatic cases. “Probably the best way to treat a minor testostero­ne deficiency is simply to lose weight,” he says. “Eat well, diet properly, exercise, and your testostero­ne level will naturally come up.”

In all, the treatment options provide a very positive outlook for men with testostero­ne deficiency syndrome, and most importantl­y, the new guidelines provide a roadmap toward responsibl­e diagnosis and treatment. Hopefully these guidelines will play a major role in cutting through the fog of uncertaint­y and controvers­y that has plagued treatment of this condition in the past.

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