Testosterone deficiency can lead to osteoporosis, low muscle mass, and poor energy levels. For conditions related to the pituitary gland (e.g., a previous tumor) or the testes (e.g., Klinefelter’s syndrome), testosterone treatment is indicated and covered by the Pharmaceutical Benefits Scheme (PBS) in Australia. However, the majority of testosterone prescriptions in Australia are non-PBS and often for low-end normal testosterone levels, such as 10 nmol/L when the normal range is around 6-30 nmol/L.
Considerations for Testosterone Treatment
Testosterone treatment needs to be carefully considered because once started, it is very difficult to stop. The body’s natural testosterone production is turned off, and it generally takes 12-18 months to recover after cessation, during which time people often feel unwell. Additionally, even low-dose topical testosterone gel can significantly lower sperm production to the point of infertility.
The impact of testosterone on heart disease risk is still unclear. One study showed progression of coronary artery disease with testosterone treatment, while others have potentially shown benefits.
In chronic diseases like heart disease, diabetes, or obesity, it is common to have lowish or low-normal testosterone without an underlying cause and normal LH/FSH levels. This is called functional hypogonadism, and treatment isn’t generally indicated unless testosterone is below 6 nmol/L multiple times. Lifestyle modifications can improve testosterone levels naturally and without side effects.
The T4DM Study
A study called T4DM involving people with low-normal testosterone, obesity, and pre-diabetes showed some potential benefits. There was a slight reduction in developing type 2 diabetes, but more significant were the improvements in muscle mass and quality of life. However, many participants (20%) had to stop treatment due to dangerously high hemoglobin levels.
Key Takeaways
- Lifestyle First: Low testosterone associated with chronic disease, especially obesity, can be improved with even small amounts of weight loss and exercise. This is why lifestyle modification is always the first line of treatment in functional hypogonadism.
- Careful Consideration: Starting testosterone should be carefully considered in consultation with an endocrinologist due to the many side effects and the difficulty in stopping treatment.