Testosterone replacement can affect sex drive, osteoporosis

DEAR DR. ROACH: I am a 67-year-old male in fair to good health (more good than fair, really).

In a recent column, you mentioned that a good testosterone level for a man taking a replacement would be between 500-600 ng/dl.

In November 2016, I was tested for my testosterone level. At the time, I was (and still am) suffering from a low sex drive and erectile dysfunction. My level was 290 ng/dl.

The reference range my primary care doctor bases his judgment on has an acceptable range from 193-950 ng/dl; hence he said my level was “low normal.”

When looking at the symptoms of low testosterone, I noted that I have at least four symptoms: low sex drive, ED (for which I have already been treated with a prosthetic implant), loss of body hair (especially my legs) and, most notably, osteoporosis (for which I take alendronate sodium, 70 mg weekly). I was diagnosed in November.

I also am being treated for depression and anxiety disorder, and have been since 2001. I don’t know if this is related to my testosterone level.

Should I talk to my doctor about the disparity I’ve found in reference ranges? Should I be seeking treatment for the low testosterone?

ANSWER: I think you definitely should speak to your primary care physician. You also might benefit from a discussion with a urologist or endocrinologist with experience in treating men with testosterone replacement.

When we look at normal testosterone levels by age, we find that older men have lower normal levels; however, given your symptoms and result, I certainly would think a trial of testosterone would be appropriate.

I must say that I am surprised that you had an implant placed without a trial of testosterone first.

I also am surprised you were treated for osteoporosis without a trial of testosterone replacement, which has been shown to improve bone density in men with low testosterone levels (one study treated men with a testosterone level below 350; another if they were below 320).

Low libido and erectile dysfunction both frequently respond to testosterone replacement: Some men get benefit in their mood as well. You sound to me like an excellent candidate for testosterone replacement.

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