The crisis of low testosterone and what doctors advise patients

Men’s testosterone levels have been declining over the last few decades, and no one knows exactly why. But South Florida doctors and researchers offer new ways to combat the problem.

When a man’s level falls below normal, his sex drive, energy levels, body hair, and muscle size are affected. Low testosterone also can be a trigger for depression.

A simple blood test  — at home or in a lab — can reveal whether testosterone levels are low.

South Florida doctors say they now have many options to raise testosterone levels: shots, gels, patches, and more recently, pills.

Pembroke Pines urologist Maury A. Jayson says he treats many patients for low testosterone. “It’s a huge health issue,” he said. Jayson advises against patches (they tear up the skin) and topical gels (they run off as men sweat in hot South Florida).

“I use mostly injections or self-injections,” he said. “There have been new formulas.”

Another newer option is pellets. “I insert testosterone pellets under the skin twice a year,” he said. Jayson said with the pellets the dosage is customizable, and the effects are long-lasting. “It’s convenient for men who are busy, and the levels stay elevated consistently over four to six months,”

Treatments for low testosterone typically have side effects: One side effect can be infertility. For older men, this may be less of a concern than for younger men who are still planning to have children.

At the University of Miami, researchers studied a nasal testosterone gel in a clinical trial. The results proved promising for younger men looking for a method to raise their testosterone levels without infertility.

The nasal gel is short-acting and doesn’t cause the body to maintain high testosterone levels throughout the day. Because it’s short-acting, it preserves the production of hormones from the pituitary gland responsible for sperm production.

“We did a trial to see whether nasal gel would maintain sperm production, and it did,” said Dr. Thomas Masterson, assistant professor of clinical urology at UM. “There was still some sperm production decline, but the overwhelming majority maintained sperm count while on that drug.”

In the last few years, the U.S. Food and Drug Administration has approved oral medications to boost testosterone — Jatenzo, Kyzatrex and Tlando. However, they have side effects that include an increase in blood pressure, and possible liver injury. “Because they are so new, our experience with these drugs is still somewhat limited,” Jayson said.

“I don’t prescribe those as much because of insurance issues,” Masterson said.

Doctors say supplements such as vitamin D, zinc and magnesium may also help to boost testosterone.

“When there is a sea of options, we want to tailor these medications to the patient,” Masterson said. “I pick and choose what may work better for each patient.”

Urologists advise looking at your health as a whole, rather than rushing to take testosterone boosters. “Low levels can be caused by other factors, including medication side effects, obstructive sleep apnea, thyroid problems or diabetes,” Masterson said.