May 2005
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Testosterone 'tune-up' can rev up sex drive
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Growing numbers of aging men turn exclusively to drugs designed to correct erectile dysfunction for their sexual woes, but urologists at Baylor College of Medicine in Houston say they may be limiting their options.
"The drugs now available to treat erectile dysfunction all work better when a man's testosterone is normalized because they depend on a biochemical system in the body that is testosterone-dependent," said Larry Lipshultz, MD, a professor of urology at BCM. "The more testosterone you have, the more the ED therapy has to work on to enhance erection and treat erectile dysfunction."
Lipshultz and other urologists have seen success in the combined use of drugs for erectile dysfunction with testosterone (or androgen) replacement therapy in some patients. Lipshultz determines which patients stand to benefit most from the two therapies by assessing their symptoms and taking blood tests that confirm androgen deficiency.
"A patient who has erectile dysfunction may have low testosterone levels," said Lipshultz. "Some patients take testosterone and then no longer need their erectile dysfunction drugs."
Men with low testosterone levels are typically over 40 and have symptoms so subtle and generic - including fatigue, mild lapses in cognitive function, low sex drive, and problems losing weight - that their conditions are often misdiagnosed as depression.
"Unfortunately, a large number of men are being put on antidepressants who really need to have their testosterone checked because men's testosterone does decrease with aging," Lipshultz said. "Androgen deficiency is something that we now know does exist, can be measured, and is easily treatable."
A greater awareness of "andropause" or ADAM (androgen deficiency of the aging male) would result in more accurate diagnoses, Lipshultz said. Furthermore, the advent of a topical androgen gel in recent years provides a more appealing alternative to traditional injections, patches, and oral medications that were previously the only way to correct this deficiency. The latter two can cause skin irritation and liver toxicity, respectively.
While there are no known major side effects to using either testosterone replacement or treatments for erective dysfunction, they could increase the risk of blood clotting because of high levels of iron-containing blood cells. Careful monitoring of these levels can prevent health problems from developing, however. Men trying to have children should avoid testosterone treatment because it turns off sperm production.
Prostate cancer patients should also not take androgen supplements since their tumors are testosterone-dependent. No large studies so far suggest that testosterone treatments can cause prostate cancer, but they can stimulate existing prostate cancer cells.
The U.S. Food and Drug Administration remains concerned about a possible link between increased testosterone levels and prostate cancer, said Lipshultz. However, he said, it could stimulate the growth of as-yet unrecognized prostate cancer cells.
"If you give someone with prostate cancer extra testosterone, you're basically feeding the tumor," Lipshultz said. "But if the tumor was removed entirely at the time of surgery and if that person goes two years with a non-detectable PSA, then we do treat men with low testosterones, and we have had no problems."
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