To T or not to T?  That is a great question.

I care for many athletes with sports hernias and classic hernias. Athletes always want to take advantage of ways to improve their recovery and strength. So I often get questions about testosterone. Testosterone is a key hormone that helps maintain a healthy body in both men and women. We will only deal with the male half of the discussion today. Once a man hits 40 years old the production of testosterone slowly decreases. This can result in loss of muscle mass, weaker bones, less energy, loss of libido, erectile dysfunction, memory loss, depression, and more. Testosterone replacement can be a great help, and older men with symptoms should consider testosterone replacement therapy.

Before you start therapy you need to be evaluated by your doctor. He or she will perform a careful history and physical examination and blood tests. This is to be sure that your symptoms are not related to some other problems such as low thyroid, anemia, cardiac disease, renal disease, or diabetes. If you have prostate cancer, testosterone may make the situation worse.

Once testosterone replacement therapy is started, there are several things that you should know. Testosterone will make you feel better, but you are not going to feel like you are 18 years old again. So expect improvement but not miracles. Acne is occasionally a problem. You may grow hair in places that you do not want and lose it in areas that you do want. There is some evidence that you may be at increased risk for heart attack in the first year of treatment. Some men retain salt and water that can result in an increase in your blood pressure and cause swelling. You can become emotionally unstable (rage). Sperm production may decrease this may not return to normal even if replacement therapy is stopped. Occasionally, the body will convert testosterone to estrogen causing gynecomastia. Testosterone will increase your production of red blood cells, so your blood counts need to be monitored to be sure that your blood does not get too thick, this can increase the risk of DVT. A testosterone blood test should be done periodically. Testosterone replacement is often a life-long treatment.

Testosterone comes in various forms; Oral, injectable, and cream. There is some risk of liver damage with the tablets, so it is not a good choice. The testosterone shots are usually given once a week.This result is a high blood level right after the injections and then the blood levels fall. Resulting in high peak and trough blood levels, I advise patients to use the cream. The cream is applied to the skin once or twice each day. The cream results in the most stable blood levels. It needs to be noted that testosterone can be transferred to others, so until the testosterone is absorbed avoid direct skin to skin contact with others (about 30 minutes). The testosterone cream is not covered by most insurance companies. Expect to pay about $40/month.

Testosterone replacement is not a replacement for regular exercise and a well-balanced diet.