At a 2013 Annual Meeting sponsored by The Endocrine Society, many of the speakers were from the international endocrinology community. They praised testosterone replacement therapy for many unwanted symptoms and signs associated with aging-related hormone declines, and published their clinical practice guidelines.  Let’s consider who is a candidate for testosterone, the potential adverse effects, and important blood tests to manage replacement therapy.

Who is a candidate for testosterone therapy? According to a report in a 2014 Journal of Sexual Medicine, a synthesis of international experts emphasized the diagnostic limitations of using a serum testosterone level as the only reason for replacement therapy, and revealed that symptoms of low testosterone are the foremost criteria for determining this.

What are the symptoms of low testosterone in men and also in women? Let’s look at these. In men, low testosterone is seen by the following symptoms and signs: Fatigue, overall lack of energy Difficulty with concentration and memory; brain fog Loss of motivation at work and in life, mild depressed mood Irritability (increased anger, agitation, or loss of patience) Reduced muscle mass and strength Increased body fat, gynecomastia (enlarging breasts), decreased body hair Decreased interest in sex or drive Erectile dysfunction, delayed refractory period (time it takes to have sex again) Hot flashes Infertility Insomnia Thinning dry skin

In women, low testosterone is seen by the following symptoms and signs: Reduced muscle strength and tone, easy fatigue with exercise Difficulty losing weight Decreased interest in sex Difficulty concentrating, mood swings, low mood, anxiety Hair loss

Therefore, if one or more of these symptoms deserve improvement, you are likely a candidate for testosterone replacement.

According to the Endocrine Society, there is overwhelming evidence of benefits of Testosterone therapy, but you must have “…unequivocally and consistently low serum T concentrations” in order to fit their criteria for replacement therapy. Therefore, a serum free testosterone level is the first and main blood test to have performed. If your level is close to or below the normal lab reference range, then there will be little question of benefit from testosterone replacement therapy.