This is Part III of a three part series on Testosterone and Sexual Functioning

Part I addressed the decline of testosterone over the course of man’s lifespan and how this decline has a role in decreased sexual functioning, and Part II addressed more specifically those sexual changes.  This final section, Part III will address therapy for testosterone decline. 

Testosterone therapy can help relieve the symptoms of testosterone decline, whether it comes from aging or other causes but it remains unclear whether or not restoring testosterone to youthful levels will be of benefit.  Debate continues, and research may eventually answer some of these questions.

Only a few, small, short-term studies have examined whether or not testosterone therapy might improve mental function in healthy older men, but studies have found some connection between higher testosterone levels and better performance on cognitive tests.

Testosterone replacement is not a magical solution to the problems of aging.  Symptoms can include fatigue, weakness and sexual dysfunction.  Because these symptoms are non-specific to testosterone decline, they may be the result of other problems.  It must be accompanied by life style changes that focus on diet and exercise.  In some cases antidepressants may be indicated.  Treatment must also address the impact of side effects of medications, and in particular drug interactions.  When sexual dysfunction is primarily related to psychological reasons, counseling may be required.

If testing reveals that testosterone levels are low, replacement therapy should be considered, and it can be accomplished in a variety of ways: Injection, patches or a gel which is spread on the skin.  Therapy may restore levels without improving the symptoms attributed to testosterone decline, and as with all medications, a consideration must be made of the balance between risks and benefits.

 Testosterone is often equated in the popular culture with the macho male physique and virility, and is viewed by some as an anti-aging tonic.  It is important to remember that the growth in its reputation and increased use has been out-paced by scientific evidence about the potential benefits and risks.

Testosterone replacement therapy is contraindicated in men with known prostatic cancer.  Transfer of testosterone to others (and to pets) through skin-to-skin contact must be avoided; it can produce fetal harm and contact with it should be avoided by women who are or can become pregnant.  Careful monitoring by your physician may be needed if you are taking insulin, steroids or medications which slow blood clotting.  It is important to inform all of your health care providers that you are taking the medication, and laboratory test values may be affected.

Testosterone replacement therapy can be expensive, and it may not be covered by all insurance plans.

Research thus far does not prove that testosterone supplements can reverse cognitive or sexual decline as men get older.  Larger randomized clinical trials in older men will need to be completed before we can say with confidence that testosterone supplements are beneficial and safe

1. Allen Langston says:

   November 27, 2009 at 2:55 pm

   Hello Loren,
   Thanks for message about your testosterone writings. I was diagnosed by a doctor as having a low testosterone level. I was originally prescribed Androgel and found it to be terribly expensive. I went on Medicare in March and completely used up the benefits by July.
   I’m now taking injections once monthly and am doing well on it. I do know that after I started taking it 3 years ago I did experience an increase in energy and libido…especially libido. I have been told that I’ll have to continue the injections for the rest of my life but I don’t anticipate that as a problem. Al
2. Loren A. Olson M.D. says:

   November 27, 2009 at 3:04 pm

   Thanks for your comment. Are the injections a lot less expensive?

   I have heard other stories about increased libido. One man told me that he now has started waking up with erections again as he did when he was younger. That seems pretty “solid” evidence that the effect of the medication isn’t just a placebo response.
3. John Brown says:

   February 21, 2010 at 10:25 pm

   Hello Dr. Olson,

   After complaining to my pyschiatrist about having no sex drive, he checked my testosterone level. I thought the Cymbalta I have been on for years was causing it. My levels came back and it was very low, around 100. I went to an endocrinologist and he put me on Androgel. I have been on it for about 8 months now. I have my sex life back!!

   Before I started Androgel, I was chronically depressed, couldn’t concentrate and I maybe had sex with my partner maybe twice a month. Now that my T levels are normal, I can concentrate, I’ve cut my Cymbala dosage by 50%, and my sex life is 2 to 3x times a week now. I even wake up with morning erections like I did when I was younger!

   I just wanted you to know that this medicine is the real deal. My life is SO different now. I’ve not been depressed since I’ve started this medicine. I was off of my Cymbalta completely for around two months, but my physchitatrist put me back on it due to my mild anxiety. I really enjoy your website! Thanks for being here!
   John
   Nashville, TN
4. Loren A. Olson M.D. says:

   February 21, 2010 at 10:50 pm

   John,

   Thanks for you comment and you bring up a very interesting point. Depression takes away a person’s ability to anticipate pleasure about most things, and of course, that means, a loss of interest in sex for many people. Additionally, many of the medications used to treat depression do cause a loss of intrest in sex and in some cases difficulty in achieving orgasm. For some, it becomes a choice between being depressed and no interest in sex, or being on a medication which helps with the depression, but still no interest in sex.

   What can happen is what happened for you, both depression and reduced testosterone levels. In your case, the hormonal replacement with testosterone, treated the deficiency and also helped with the depression. That’s a real win/win for you.

   I had a similar response with Androgel. I have to admit I was skeptical when I began the treatment, but I began experiencing morning erections, too, and I realized that was certainly not a placebo response to it. That in itself has a psychological effect: Feeling younger, more alive, more sexual. Both interest and performance improved which restored some of the confidence I’d lost.

   Thank you for your interest and your comment. I look forward to more from you.

   Loren Olson