Patient education: Androgen replacement in men (The Basics)

What are androgens? — Androgens are a type of hormone the body makes naturally. Hormones are chemical messengers that turn different body processes on and off. Androgens are often called "male hormones." That's because they are the main hormones that make males different from females.

People often think that only men have androgens and only women have female hormones (called "estrogens"). But the fact is, men and women both have androgens and estrogens. The difference is that men normally have much higher levels of androgens than women. And women normally have much higher levels of estrogens than men.

Why might I need androgen replacement? — You might need androgen replacement if you have low levels of an androgen called "testosterone." There are a few different androgens, but testosterone is the main one.

Symptoms of low testosterone can include:

●Feeling tired, especially at the end of the day

●Having little or no interest in sex – Doctors call this "low libido."

●Not being able to get or keep an erection when you have sex – Doctors call this "erectile dysfunction."

●Feeling depressed

Are there tests that can tell if I need androgen replacement? — Yes. If you have symptoms of low testosterone, the doctor or nurse will do an exam and learn about your symptoms. They will also order a blood test to check your testosterone level. The test should be done in the morning, before 10:00, to get the most accurate results. If the results show that you have low testosterone, the test will be repeated to confirm this. Depending on your situation, you might also have other tests.

It's important to talk to your doctor if you think you might need androgen replacement. That way you can get tested to see if low testosterone is really the cause of your symptoms. (There are other problems that can cause symptoms like feeling tired and losing interest in sex.)

What are the benefits of androgen replacement in men? — The benefits include:

●Improved interest in sex

●Improved energy

●Being less depressed or irritable

Does androgen replacement cause side effects? — Some men who have androgen replacement with testosterone have side effects. These can include:

●High amounts of red blood cells, especially in men who take testosterone shots

●Acne

●Blood clots (but this is rare)

●A possible increase in the risk of heart attack or stroke – Experts are worried that testosterone treatments might increase the risk of heart attacks and strokes in some men. This is not likely to be a problem for men who are known to have low testosterone and are getting treatment to bring the level up to normal. But doctors are careful about when to suggest testosterone, because it can cause problems in men whose levels are already normal.

If you are getting androgen replacement, you will need regular exams and blood tests. This is so your doctor can monitor your testosterone levels and blood cell counts and look for any side effects.

How is androgen replacement given? — There are several different forms. Testosterone comes in different forms, including a shot, gel, or capsule. The table lists the names of different androgen replacement medicines (table 1).

If you use testosterone replacement gels, you must wash your hands after putting on the medicine. That's because testosterone can get on other people's skin. If this happens, it can cause harmful side effects, especially in children. Always put the gels on skin that is covered by clothes. This can help keep testosterone from getting on other people.

Should men over 60 have androgen replacement? — That's not always clear. Low testosterone is not always treated, especially in men older than 60. That's because it's normal for testosterone to drop slightly as you age. In fact, normal aging causes some of the same changes that happen in men with low testosterone, such as less energy or less interest in sex.

Men older than 60 might have testosterone replacement if:

●At least 2 or 3 blood tests show very low testosterone

●They have symptoms of low testosterone that bother them, like feeling very tired and having a low sex drive

●The symptoms are not caused by another disease or condition that doctors can treat

●They have not had a heart attack or stroke

Older men who have testosterone replacement need regular screening tests for prostate cancer.

More on this topic

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Patient education: Sex problems in males (The Basics)
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Patient education: Low testosterone in men (The Basics)

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