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Medically Reviewed by Dr. George Touliatos
Around 40% of men over 45 have testosterone levels below 300 nanograms per deciliter (ng/dL), which may reduce their ability to perform day-to-day activities properly.
Many older men experience reduced sexual function, bone breaks, low muscle mass, and anaemia as they age. All these issues are hypothesised to be related to low testosterone levels, which are believed to occur as men age.
To overcome this issue, some healthcare providers prescribe testosterone replacement therapy (TRT) to their patients. In this treatment, you take synthetic testosterone to bring your testosterone levels back to normal. As a result, your low T symptoms start going away.
The use of TRT has increased widely over the years. According to an article published in Clin Endocrinol (Oxf), testosterone prescriptions have increased by 90% in 10 years (2000-2010) in the UK. It has increased many times by now and is expected to increase more in the coming years.
Despite the usefulness of TRT for younger men, it is often questioned whether the same treatment is as effective for older men as it is for younger men.
In this article, we will evaluate the findings of 6 testosterone trials (T trials) launched by the National Institute on Aging to see whether TRT can help ageing men or not.
T trials are a multicenter study of 6 trials performed in 12 sites across America. The aim of the study was to analyse the changes produced by testosterone in men over 65 with serum testosterone levels below 250 ng/dL.
During these trials, 790 men were randomly given either a placebo or testosterone gel. They were asked to apply the gel every day to the upper arms, shoulders, and abdomen for 1 year.
Their serum testosterone levels were checked every 30 days for the first 3 months and then during the 6th, 9th, and 12th months. Their dose was adjusted during these months if their testosterone levels were not between 500 and 800 ng/dL.
Men with low T experience problems gaining and maintaining an erection. In addition to this, their sperm count and desire to have sexual activity also decline.
The results of the Sexual Function Trial were published in 2016 in the New England Journal of Medicine. Researchers concluded that increased testosterone levels improved erectile function and sexual activity in participants who used testosterone gel.
Low T is also believed to induce depression, reduce energy levels and increase fatigue.
Results of the Physical Function Trial and Vitality Trial showed a significant improvement in depressive symptoms, energy level, and mood of participants. However, no noticeable change was observed in walking ability.
Anaemia, also called low haemoglobin, is a condition in which your red blood cell count declines; as a result, your body tissues and cells do not receive enough oxygen to perform their functions normally.
It is a common condition in older men. However, healthcare providers often have trouble diagnosing the real cause of this issue in older men.
An anaemic person often feels tiredness, weakness, dizziness, and headaches. The condition can range from mild to severe. Long-lasting anaemia can cause serious health effects, including damage to the brain and other vital organs.
Results of the Anaemia Trial were published in 2017, and they showed that testosterone gel considerably increased red blood cell production in older men suffering from anaemia.
Men with low T often experience bone strength and mineral density reduction, which may result in frequent bone breakage incidents.
During the Bone Trial, the bone volume of older men having testosterone therapy was checked using DEXA (dual-energy x-ray absorptiometry) technology. Similarly, bone strength was analysed using CT scans.
By the end of the research, participants had more bone strength and bone density scores. An increase in bone strength was more prominent in vertebrae compared to the hip bone.
Older men often report a decline in cognitive function. As testosterone levels also decline with age, some experts believe that there might be a connection between low testosterone and poor cognitive health.
However, the results of the Cognitive Function Trial did not show any improvement in memory impairment in participants who applied testosterone gels for 1 year.
As men age, their cardiovascular health declines, which increases the risk of heart disease.
The results of the Cardiovascular Trial showed that testosterone might increase the risk of cardiovascular issues in older men.
Results of 6 trials indicate that testosterone therapy offers some benefits to older men with low T, but it is also associated with a few risks. However, the benefits of the treatment outweigh its disadvantages.
Researchers believe that more long-term studies need to be done to better understand the effectiveness of the treatment.
The decision about whether to have or not have testosterone should be made between the patient and his healthcare provider.
Each low T case is different to another. You need to discuss your medical history and current health condition with your doctor, so they can better understand your body’s condition and decide whether you should go for TRT or not.
TRT has helped many older men improve their low T and live healthy lives like before. Therefore, if you are interested in starting TRT, it is suggested that you first talk to your doctor, get their suggestion and then choose a treatment option that is more suitable for your condition.
TRT is available in different forms, giving older men different options to choose from. You can find testosterone in pellet, injection, pill, gel, and transdermal patch forms. Now, you may think which form of testosterone I should take. The answer to this question entirely depends on your preferences and lifestyle.
People who are afraid of injections often might go for other options. Similarly, people who prefer oral medications over gels, pellets, and injections choose testosterone pills.
Each form of testosterone comes with its own pros and cons.
Pros: It is easy to apply, and you can apply it on your own. You have to apply it every day; therefore, testosterone is released in your body steadily and its level is well-maintained.
Cons: You have to wait for the gel to dry before touching any surface. There is always a risk of transferring testosterone to others around you through skin-to-skin contact.
Pros: One injection a week can maintain your testosterone levels throughout the week. Therefore, you will not have to worry about taking testosterone every day. Testosterone injections are very effective and provide your body with testosterone within a few hours of being administered.
Cons: You may experience mild soreness at the site of injection. Visiting your healthcare provider to take a testosterone shot may also seem time-consuming.
Pros: They are easy to swallow. You don’t feel any pain as you may feel while taking testosterone injections.
Cons: Oral medications are not as effective as injections and gels. They have poor bioavailability, meaning they are poorly absorbed in the body. Due to this reason, you may have to take 3 to 4 pills every day to sustain your testosterone levels and see their effects.
Pros: They are placed under the skin and can last for 4 to 6 months, providing a long-term solution and testosterone availability.
Cons: A permanent scar forms on your skin where the pellet is placed. If inserted incorrectly, the patient may develop an infection.
Pros: They are easier to apply and remove.
Cons: They may cause skin irritation.
Testosterone is an important male hormone; that is why men experience different issues when their testosterone levels decline. Enlisted below are some of the most common roles of testosterone in men’s bodies.
When your testosterone levels decline due to old age, you may notice a reduction in your bone density, muscle mass, sexual desire, and sperm count.
Testosterone replacement therapy shows some benefits for older men, such as an increase in bone density, reduction in anaemia, improvement in mood, and more sexual desire.
If you wonder whether this treatment option is right for you or not, talk to your healthcare provider and discuss its pros and cons.
Your healthcare provider will likely measure your testosterone levels, observe your symptoms, and evaluate your medical history before recommending testosterone replacement therapy.
References/Citations/Bibliography/Further studies/Scientific studies
https://www.clinicaltrials.gov/ct2/show/NCT00799617
Gruenewald, D.A. and Matsumoto, A.M., 2003. Testosterone supplementation therapy for older men: potential benefits and risks. Journal of the American Geriatrics Society, 51(1), pp.101-115.
Stanworth, R.D. and Jones, T.H., 2008. Testosterone for the aging male; current evidence and recommended practice. Clinical interventions in aging, 3(1), p.25.
This article has been researched and written based on scientific evidence and fact sheets that have then been crossed checked by our team of doctors and subject matter experts.
References, sources and studies used alongside our own in-house research have been cited below, most of which contain external clickable links to reviewed scientific paper that contain date stamped evidence.
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Mike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones Ltd which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy (TRT) and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.
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