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Testosterone is the sex hormone that transforms little boys into men. Its importance to sex drive — in both males and females — has long been recognized. However, preliminary findings from a recent study indicate that testosterone replacement therapy can reinvigorate the sex lives of older men in a couple of other ways as well.
The study, led by Glenn R. Cunningham, M.D., professor of endocrinology at Houston’s Baylor College of Medicine, showed that T-replacement therapy in older men produced moderate but significant improvement not only in sex drive but in erectile function and sexual activity as well.
Findings ‘Pretty Remarkable’
Dr. Cunningham characterized the study’s findings that T-replacement improved three key measures of sexual function — desire, sexual activity, and erectile function — as “pretty remarkable, particularly when you’re dealing with an older age population.”
The study, part of a nationwide initiative entitled the Testosterone Trials, or TTrials, was previewed online in late June 2016 in advance of eventual publication in the “Journal of Clinical Endocrinology & Metabolism.”
AbbVie Inc., which manufactures and markets AndroGel, a T-replacement therapy, supported the study by providing AndroGel and placebo gel but otherwise had no role in the design or conduct of the trial or the collection and analysis of data.
Don’t Expect Miracles
Brad Anawalt, M.D., a professor of endocrinology at the University of Washington School of Medicine, was not a member of the research team that conducted the study, but he did review its findings after the study was completed. He suggests that it would be wrong for older men to think that T-replacement will transform them into sexual dynamos, but he said they clearly can expect measurable improvement in sexual desire and function.
In an interview with HealthDay reporter Dennis Thompson, Dr. Anawalt said, “Men treated with testosterone reported an increase in orgasm of about one every week versus one every 10 days. That works out to one more orgasm per month compared to placebo.” Whether or not that’s significant, said Dr. Anawalt, is “up to the man.”
470 Study Participants Recruited
The research team, which included representatives from 12 academic medical centers across the United States, recruited a total of 470 men who were 65 or older at the outset of the study. All study participants were required to have a partner willing to have sexual intercourse at least twice a month. The average blood testosterone level among participants was less than 275 nanograms per deciliter.
The study participants were randomly assigned to use either T-replacement gel or a placebo over the course of 12 months. Participants were required to fill out three questionnaires assessing sexual desire, function, and activity at the outset of the study to establish baseline values. At three-month intervals thereafter, including the 12-month conclusion of the study, they supplied responses to the same three questionnaires to determine how they were responding to treatment.
Questionnaires Identified
The three questionnaires used for this multi-institutional study were the Derogatis Interview for Sexual Function, International Index of Erectile Function, and Psychosexual Daily Questionnaire. In the conclusion to their study, researchers noted that T replacement therapy significant increased 10 of 12 measures of sexual activity, when compared with the results of men receiving placebo.
The 10 measures of sexual activity significantly increased by T-replacement therapy were sexual daydreams, anticipation of sex, sexual interaction with partner, flirting by subject, ejaculation, orgasm, intercourse, masturbation, spontaneous nighttime erection, and sexual arousal erection. The two measures of sexual activity that showed no significant change when T-replacement therapy was compared with placebo were flirting by others and spontaneous daytime erection.
‘Normal Is Normal’
Also interviewed by HealthDay’s reporter was Landon W. Trost, M.D., an assistant professor of urology and specialist on male sexual dysfunction at the Mayo Clinic in Rochester, Minnesota. He said that the study shows that older men who experience normal declines in testosterone levels can benefit from T-replacement theory. “The study argues that normal is normal,” he said, adding that even an age-related decrease in T-levels should be considered abnormal.
Testosterone replacement therapy is available in a few different forms. The cost of testosterone gel ranges from $200 to $400 a month, according to HealthDay. Testosterone injections cost less than $100 a month. Also available are implantable testosterone pellets that release controlled amounts of the hormone over time. Using this form of therapy costs roughly $1,000 every three to four months.
Not for Everyone
Despite the promising findings from this latest study, Dr. Cunningham cautioned that T-replacement therapy might not be advisable for everyone. He pointed out that the goal of the TTrials study was to evaluate the efficacy of T-replacement in older men. Safety concerns were not addressed at all. “I think you do have to recognize there is potential risk with testosterone in older men, and so you have to balance that,” he said.
Prior research has indicated that T-replacement therapy can increase a man’s long-term risk of prostate cancer and heart disease, according to Dr. Cunningham. One of the side effects of testosterone replacement is a thickening of the blood, which can increase the risk of heart attack or stroke.
T-Levels Peak at Age 20
Beginning at about age 20, the testosterone level in men declines at a rate of roughly 1 percent per year. However, normal T-levels in men range widely from a low of 270 nanograms per deciliter to a high of nearly 1,100 nanograms per deciliter. The average T-level for men of all ages is 679 nanograms per deciliter. T-levels below 270 nanograms per deciliter are considered low.
According to WebMD.com, roughly four out of every 10 men over the age of 45 suffer from low testosterone. According to S. Adam Ramin, M.D., medical director of Urology Cancer Specialists in Los Angeles, men today pay far greater attention to testosterone levels than was the case a decade or more earlier. “Some of my patients are proactive and come into my office to find out about their levels, said Dr. Ramin, “but others may not want to talk about it all.”
Symptoms of Low-T
As previously noted, testosterone levels are closely associated with sex drive. So a loss of desire for sex can be one sign that a man is suffering from low T. Other symptoms may include depression, difficulty concentrating, enlarged breasts, fatigue, fertility problems, hair loss, irritability, testicular changes, and weight gain, particularly around the mid-section.
If you’d like to read more about male and female sexual function, as well as other topics of interest to health consumers, check out our blog.
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