Q: A friend of mine was diagnosed with a low testosterone level. His doctor prescribed a cream that he rubs on his shoulders that has testosterone in it. He tells me it really makes a difference. He has more energy, he’s less depressed, and he has more of a sex drive. Is this something I should ask my doctor about?
A: The short answer is “No” if you aren’t depressed, have plenty of energy and have a strong sex drive. But if any of those are issues for you, you should definitely ask your doctor to test your testosterone level. (It’s also called a “T level,” not to be confused with that other “T” that might well kill you.) That is an especially important test for men with HIV, many of whom tend to have low testosterone levels. Oddly, it’s a test most doctors don’t administer as part of your routine blood work when you are HIV positive, and certainly don’t administer if you’re not.
The test will show whether your testosterone level is “normal” for your age range. But there are a couple of issues there too. First, different labs use different methods to measure testosterone. So your T might be higher or lower, depending on who’s doing the measuring. A second issue is that many only test your “total” testosterone level. There actually are three types of testosterone in your blood. You want a test of “free” T.
Another issue is a cultural one. Older men naturally have lower testosterone levels. So if you are 60 when you get tested, you might have a “normal” level that would seem low for a 32-year-old. Your doctor might tell you you’re doing just fine. But in our gay world, 60-year-old gay men usually aren’t ready to slide into retirement or a nursing home. They want to know why they shouldn’t have a chance to feel 30 all over again.
If your doctor is willing to prescribe testosterone therapy (and you should consult a gay or gay-friendly doctor on this matter), you should know that there are five kinds:
1) One is a gel or cream (brand names include Testim and AndroGel). You must spread it on your body (usually across your shoulders) once a day. This works for many men, although some object to the chemical odor. And many gay men have commented on how straight women suddenly perk up and flirt when they start using Testim or AndroGel.
2) Testosterone patches, which you apply every day to your abdomen, upper arm or thigh and leave in place for 24 hours. That’s not a pretty sight on the beach, and some men say it irritates their skin.
3) Testosterone pills (Andriol Testocaps), which are taken two to four times a day. They can be expensive and are generally considered less effective than other options.
4) Injections, weekly or biweekly, of testosterone cypionate. You have to be willing to give yourself a shot to use this therapy. Also, your testosterone level will rise when you give yourself a shot and gradually fall until the next shot, which disturbs some men.
5) Testosterone pellets (Testapel), which are injected under the skin on your butt and abdomen and release testosterone slowly over time. These injections require a local anesthetic. But the good news is that you don’t have to think about your testosterone level for four to six months, when the injected pellets have run their course and you need a new injection.
As with every medication, there are risks. The federal Food and Drug Administration announced in January that it is beginning a study of those risks, which include an increased risk of heart problems. Also testosterone therapy isn’t given to men with prostate cancer because it speeds the development of a tumor.