Dear Dr. Roach • I am a 67-year-old male in fair to good health (more good than fair, really). In a recent column, you mentioned that a good testosterone level for a man taking a replacement would be between 500-600 ng/dl.
In November 2016, I was tested for my testosterone level. At the time, I was (and still am) suffering from a low sex drive and erectile dysfunction. My level was 290 ng/dl. The reference range my primary care doctor bases his judgment on has an acceptable range from 193-950 ng/dl; hence he said my level was “low normal.”
When looking at the symptoms of low testosterone, I noted that I have at least four symptoms: low sex drive, ED (for which I have already been treated with a prosthetic implant), loss of body hair (especially my legs) and, most notably, osteoporosis (for which I take alendronate sodium, 70 mg weekly). I was diagnosed in November.
I also am being treated for depression and anxiety disorder, and have been since 2001. I don’t know if this is related to my testosterone level.
Should I talk to my doctor about the disparity I’ve found in reference ranges? Should I be seeking treatment for the low testosterone? — J.P.P.
Answer • I think you definitely should speak to your primary care physician. You also might benefit from a discussion with a urologist or endocrinologist with experience in treating men with testosterone replacement.
When we look at normal testosterone levels by age, we find that older men have lower normal levels; however, given your symptoms and result, I certainly would think a trial of testosterone would be appropriate. I must say that I am surprised that you had an implant placed without a trial of testosterone first. I also am surprised you were treated for osteoporosis without a trial of testosterone replacement, which has been shown to improve bone density in men with low testosterone levels (one study treated men with a testosterone level below 350; another if they were below 320). Low libido and erectile dysfunction both frequently respond to testosterone replacement: Some men get benefit in their mood as well. You sound to me like an excellent candidate for testosterone replacement.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Drive, Orlando, Fla. 32803. Health newsletters may be ordered from rbmamall.com.