Should I try testosterone treatment to treat low-normal testosterone?

DEAR DOCTOR K:

I’m a 68-year-old man who has been feeling more tired and less “sexy” over the past several months. My doctor says my blood testosterone level is normal, but “low normal” — a little bit above low. I know that some men take testosterone gel as a treatment for this. My doctor is not so keen on that. What’s your opinion?

DEAR READER:

I don’t know nearly enough about your health or your symptoms to offer you personal advice. But I’ll tell you what I think research has shown, at least so far. I’ll warn you: It is a controversial area, and I reserve the right to change my mind as new research is published.

There’s little controversy about giving testosterone treatment when a man clearly has abnormally low blood levels, and symptoms consistent with those low levels. Such a condition is called “hypogonadism.” In such a case, treatment almost always improves the symptoms. But hypogonadism is a pretty unusual condition.

The controversy involves people like you. As men age, our blood testosterone levels generally decrease. Many men your age have levels that are in the “low-normal” range. That is, they are still normal, but on the low side of normal.

And some, but not all, men with low-normal testosterone levels have some of the symptoms of hypogonadism. Those symptoms include a diminished sense of well-being, fatigue, reduced muscle strength, moodiness, loss of sexual desire and erectile dysfunction.

The question has been: Does testosterone treatment help these symptoms, even when blood levels of testosterone are not abnormally low? Two studies published in 2015 shed some light on this question. The studies were randomized trials, the best kind of study for evaluating the value of a treatment.

The first study involved over 300 men age 60 or older with low or low-normal testosterone levels, regardless of whether they had symptoms. The men were selected at random to receive testosterone gel treatment or treatment with a placebo gel, every day for three years. The placebo gel looked just like the real thing, but contained no testosterone.

The study carefully measured all the relevant symptoms that might be caused by lower testosterone levels. The study found no significant improvement in symptoms in men given testosterone treatment, compared to men given placebo treatment.

The second study involved about 90 younger men, ages 35 to 70. They all had Type 2 diabetes, and low (or very low-normal) testosterone levels. The men were chosen at random to receive either testosterone shots or placebo shots. There were no significant improvements in symptoms of men given testosterone, compared to men given a placebo.

These recent studies, and many (but not all) previous studies, do not demonstrate a value in giving testosterone treatments to men with low-normal or slightly low blood levels of testosterone. In addition, some other studies have indicated that such treatments may raise the risk of heart trouble. So, your doctor’s disinclination to prescribe treatment seems reasonable. In a future column, I’ll talk about ways besides testosterone to improve your energy and desire.