Men—Stay On Top of Your Health

Matching the Treatment to the Problem

Suppose you find out your testosterone is in the basement...then what?

Well, you have several options. Remember, though, this is not a one-size-fits-all approach. Every man is different.

My first choice is a transdermal testosterone patch (oral testosterone is not effective and may be dangerous to the liver). The patch delivers testosterone at a controlled rate and avoids the peak-and-valley effect of testosterone injections. The best place to put the patch is on the scrotum since scrotal skin is at least five times more permeable than any other area of the skin. But I must warn you that skin irritation can be a problem for many men and scrotal hair must be shaved to secure contact with the skin. It's for this reason that pharmaceutical companies have developed 5 mg patches to be applied nightly and rotated on the body: the back, abdomen, upper arms and thighs.

The 5 mg patches are a suitable alternative to scrotal patches and can improve sexual function, energy and mood, but about 12 percent of men who use them still report burn-like blisters, which can occur after a single application.

If either type of patch irritates you, ask your doctor to write you a prescription for a testosterone cream or gel that can be applied to the backs of your knees after a morning shower.

Creams and gels are an effective remedy for treating low testosterone, and there's very little irritation. The only problem is they can be messy and sticky, and if they are applied unevenly, you may not get what you need to boost your testosterone.

Another option is testosterone injections. Even though this is the least expensive and most common form of hormone-replacement therapy for men, I do not like injections. They often result in wide swings in testosterone levels. Yes, testosterone increases, but it's often followed by low or even subnormal levels.

These disturbing fluctuations can affect a man's energy, mood, and sexual function. Some men have told me that they feel great for about a week after an injection, and then fatigue sets in and sexual desire/performance are lackluster.

Note: There are two things to consider before trying testosterone patches or injections. Overly high levels of testosterone may predispose you to acne and a blood disorder called polycythemia (excess red blood cell production).

Excessive testosterone also can lead to overly high libido, urinary obstruction, swelling of breast tissue, priaprism (excessive duration of an erection), and mood swings (especially for those receiving testosterone injections).

Also, before you begin hormone treatment, you should have a digital rectal examination and a PSA test. Once you receive testosterone, in any form, you must have periodic evaluations to make sure that no changes have occurred to your prostate gland (enlargement, cancerous changes).

For Those Who Want a More Natural Approach…

Chorionic Gonadotropic Stimulation, done through an injectable hormone, can jump-start the testes to increase testosterone production. It uses natural hormones to stimulate the Leydig cells in the testes that make testosterone. A lot of men do well with this. If you're getting sufficient testosterone production and feel good with this method, stick with it. It's best to build your own supply of natural testosterone when you can. If this method doesn't work for you, then consider one of the synthetic forms of testosterone that I've just discussed.

Another natural approach is soy (tofu and other soybean products), which can help suppress aromatase activity. Some people would say that real men don't eat tofu, but I would say that real men eat these foods! I always get a bowl of soybeans at my favorite Japanese restaurant when I go. Soy is good for any man approaching mid-life, regardless of which option he ultimately chooses. I recommend one serving of tofu or soybeans at least once a week.

Zinc (15–30 mg daily) and vitamin C (500 mg daily) also help boost testosterone production, and so does ginkgo biloba (120–240 mg daily). Many of my male patients have reported enhanced libido and erections and less depression when taking ginkgo. Researchers believe ginkgo may support the production of dopamine, one of the brain's "happy" hormones that can enhance sexual function.

Talk to your doctor about the options I've laid out here. If your health professional can't help you, ask him if he knows of an anti-aging specialist who can. The right professional may help you add years to your life and life to your years. There could be some light at the end of the tunnel for you!

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