I am a 73 year old caucasian, 6' 5" weighing 225 lbs. I am in good health, and other than a noticeable thinning of my body hair (on chest,arms legs, etc, and a bit of rather newly acquired belly fat, am experiencing no noticeable symptoms from the low T.I was recently diagnosed with low T, 5.8 Free Testosterone. My GP wants me to start using androgel on a daily basis. I am hesitant for several reasons.1. I have read that once you start taking this medicine, whatever your natural Testosterone production is, it will shut down, and quite likely your testicles will shrink noticeably.2. The medicine costs $400 per month, which I cannot afford. My current insurance would pay almost all of that, but if the HMO drops coverage, as they are wont to do, I wold basically have a $5,000 year habit.3. The diagnosis is on the basis of only one blood panel, and I wonder if some more readings should be taken over a few months to see if perhaps it improves. Also, would some holistic homeopathic supplements perhaps help? 4, anyway, what is the normal range for a man my age? How real is the danger of osteoporosis, sexual dysfunction, etc. at this level of Testosterone? My urologist did not seem particularly enthusiastic about my taking the androgel, but of course doesn't want to contradict the GP.I would appreciate your thoughts.
Person's Gender: Male
Person's Age: 73
The most important thing is to confirm that your testosterone is really low and if so why. There is a diurnal variation in testosterone with the highest levels in the AM. It is always measured between 7-9 AM and you should have a total testosterone, bioavailable testosterone, LH and prolactin. This will answer the question.
The testosterone treatment will prevent the testes from making testosterone and sperm but usually not an issue and can be reversed by stopping treatment.
There is no "normal" value in the aging male. Normals are based on healthy young men. We do know that testosterone levels drop slowly over many years starting in middle age. It can result in ED and osteoporosis but only if very low.
Finally the cheapest way to take testosterone is with an injection every 2 weeks, about 10-20 dollars/month. You can be taught to give the injection at home.
The important thing is that whatever the testosterone levels Rx is not indicated unless you have associated symptoms such as muscular wasting, fatigue, depression, ED.
Dear Doctor Isenbudthank you for your prompt reply. I must admit though, that I am still confused. I do not understand your saying that there are no "normal" values for testosterone, but then saying I need to confirm that my levels are low. I find charts showing "normal" levels in men up to age 60, and the levels get lower with age, but they are in a format I don't understand. I don't find charts which refer to free testosterone (mine was supposedly 5.8)I have definitely been losing some muscle mass, but assume that this is normal at my age? also have acquired a bit of a belly, which I didn't have two years ago.I will ask my GP to give me a referral to a endocrinologist. I just don't feel comfortable starting this medication without more information. From what you say, taking Androgel without more information and testing would be a mistake> do you agree?
The normals are generally based on young people and there is little good data on elderly. Most docs recommend treatment for lebels of total testosterone under around 200 if accompanied with symptoms. We always recheck levels in the AM to be sure we don't miss a pituitary problem.
Endocrinology and metabolism practice for 35 years