Testosterone Supplementation in Older Men with Low Testosterone Levels?

Year in Review |
December 30, 2015

Testosterone Supplementation in Older Men with Low Testosterone Levels?

  1. Anthony L. Komaroff, MD

Placebo-controlled studies suggest that such men generally don't benefit from treatment.

  1. Anthony L. Komaroff, MD

As men age, their blood testosterone levels generally decline, often to levels in the low or low-normal ranges specified by commercial laboratories. Testosterone supplementation is being prescribed increasingly for such men, some of whom report “aging-male symptoms.” Although testosterone supplementation undoubtedly improves aging-male symptoms and sexual function in men who have overt primary or secondary hypogonadism, the value of supplementation in other men has not been established.

A multi-institutional team conducted a randomized trial of 308 men (age, ≥60) with low or low-normal total testosterone (100–400 ng/dL) or free testosterone (<50 pg/mL), irrespective of symptoms. Participants were treated with either testosterone gel (dose titrated to achieve blood levels of 500–900 ng/dL) or placebo gel for 3 years. Using validated instruments to measure quality of life and sexual function, the investigators found no clear improvement in the active-treatment group. Testosterone supplementation also did not significantly affect several biomarkers for cardiovascular risk: carotid intima-media thickness, coronary artery calcium, blood lipids, or glucose level. The study was not powered to assess risk for adverse cardiovascular events (NEJM JW Gen Med Sep 15 2015 and JAMA 2015; 314:570).

In another randomized trial, investigators examined testosterone supplementation in a more targeted group — 88 middle-aged Australian men (age range, 35–70) with type 2 diabetes, mild-to-moderate aging-male symptoms, erectile dysfunction, and total testosterone levels between 144 and 346 ng/dL; the men received parenteral testosterone therapy (testosterone undecanoate) or placebo for 40 weeks. Using validated assessment instruments, the investigators found no significant improvements in aging-male symptoms (“somatovegetative” symptoms such as well-being and muscle strength, psychological symptoms, and sexual symptoms such as sexual desire) or erectile function (NEJM JW Gen Med Nov 15 2014 and J Clin Endocrinol Metab 2014; 99:3821).

These studies, and most previous studies, show no clear improvement in “aging-male symptoms” or sexual function in men with low-normal or slightly low blood levels of total or free testosterone. Because other studies have suggested that testosterone supplementation in such men raises risk for adverse cardiovascular events, such therapy is not indicated in asymptomatic or mildly symptomatic men.

Editor Disclosures at Time of Publication

  • Disclosures for Anthony L. Komaroff, MD at time of publication Editorial boards Harvard Medical School: Harvard Health Publications; Harvard Health Letter; Ask Doctor K

Reader Comments (5)

Jerry Amos BSEE BSME Other, Home

Age 77 I felt bad all day long. Blood tests showed testosterone O.K. but "free testosterone" off the bottom of the scale. Sex hormone binding globulin (SHBG) way above the scale. Estriol at the top of the scale. 0.8 ml of 10% bio identical testosterone cream I feel normal, weight and strength as usual. Attempts to lower SHBG backfire, feel worse than ever. Weird that FDA says I must sign for testosterone but opioids are fine for people down to age 11?

george smith, md Physician, Geriatrics, Retired

What about old men with levels below 50 with loss of one testicle at age 12. How about body functions such as golf and tennis, and cardiac muscle function--sleep apnea, --all improved on test. Gel past 3 years.--at age 89 shot a77 in golf tournament recently!!

george smith, md Physician, Geriatrics, Retired

What about old men with levels below 50 with loss of one testicle at age 12. How about body functions such as golf and tennis, and cardiac muscle function--sleep apnea, --all improved on test. Gel past 3 years.--at age 89 shot a77 in golf tournament recently!!

Kathy Maupin MD Physician, Other, BioBalance Health LLC

I have treated many older men with testosterone and they have benefited greatly in every area except ED, and testosterone peelts often benefits them enough to use Viagra or Cialis successfully. The success of treatment is always dose to achieve a young healthy level of testosterone, the delivery system that has the fewest side effects from conversion of testosterone to estradiol, estrone and DHT, as well as the management of other hormonal and nutritional deficiencies that increase in severity with age. My results are dramatic, with those men who have lost muscle mass have become frail asre able to leave their walkers and canes behind, Mobility and improvement in their thought process can change a man's future from a nursing home existence to a full life independently.

Ideally, starting testosterone is much more effective before these men have accumulated plaque and developed hypertension, but obvious improvement can be realized if the appropriate dose and testosterone as well as non-gel delivery system is used. I only use subcutaneous pellets because of the excellent outcomes they give my patients.

ernest schapiro Other, Psychiatry, retired

These studies don't specify whether estrogen levels were monitored or taken into account. It's easy to overlook the transformation of testosterone into estrogen and the possible implications. and complications. I'd like an explanation of this omission. from the authors.

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