By Paul Mittelstadt, M.D.
As is well-known, testosterone is one of the major male sexual hormones. It is also a female hormone with a significant role in sexual stimulation and satisfaction. Obviously, the amount of testosterone produced naturally by the male body is significantly higher than that produced by the female body. Even though it is well-known that women have menopausal symptoms from rather sudden decreases in estrogen levels starting typically in the fifth decade of life, it is not well-known that men have a gradual “menopause” from lowering testosterone levels starting in the mid 20s which is typically complete by early to mid 50s. Because of this gradual menopause, men seldom have the menopausal symptoms that women have. Rather, men have symptoms which are of gradual onset such as loss of muscle, tiredness, mild depression, loss of concentration, or difficulty obtaining or maintaining an erection. Interestingly, women tend to produce low but constant levels of testosterone during most of their lives.
Low testosterone is easily diagnosed by blood tests. Furthermore, “T” levels are divided into active “T” and nonactive “T” levels. Thus a normal “T” level needs further explanation. When asking your MD for a “T” level, in particular ask about the active “T” level. A man in his 60s may have a normal “T” level but it frequently will be almost entirely inactive “T”.
Replacement “T” comes in many forms with the two most common being either a topical gel or in an injectable form. The gel has the advantage of being easily applied daily but the disadvantage of daily good skin preparation prior to applying as well as some potential greasy feeling and clothes contact. The injectable has the advantage of once a week usage, very accurate correction to normal active “T” levels, and a short time needed to complete the weekly injection. The most common disadvantage of injectable “T” is the discomfort of the injection which can be minimized by using a small needle. A note about both gel and injectable “T” is that “T” is very heavily regulated by the DEA.
For men, when selecting an MD to be screened and treated for low “T”, PLEASE find a physician who routinely tests and treats for “Low T”. You may find an MD who can diagnosis “Low T” appropriately BUT will not accurately or appropriately treat for “Low T”. In the Twin Cities area, a few select urologists and endocrinologists are capable of diagnosing and treating for “Low T”. For women a “Low T” blood test is the norm. Yet women who are treated appropriately with testosterone frequently find significant greater enjoyment from intercourse (some reaching climax for the first time) without the dreaded fear of being masculinized. Women who wish to be tested and treated for “Low T” need to find an urologist, gynecologist, or endocrinologist that can test, treat, and appreciate the sexual satisfaction appropriate “T” treatment can give.