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There are so many diverse opinions about testosterone that it would be hard for anyone, physician or layman, to see a clear picture.

What is well established is that testosterone:

  1. Improves athletic performance
  2. Increases muscle mass
  3. Raises bone density
  4. Increases libido
  5. Often improves erectile function
  6. Reduces abdominal fat
  7. Increases red blood cell production

What has been argued is the effect of testosterone on heart disease, stroke, and mortality. A recent study reveals a powerful effect of testosterone in preventing heart attacks, stroke and death. (Normalization of Testosterone is Associated with Reduced Incidence of Myocardial Infarction and Mortality in Men, European Heart J. Aug 6, 2015)

ManIn a Veterans Affairs study, 83,000 men with low total testosterone were followed an average of 5 years. One group was given enough testosterone to restore normal levels. Another group received testosterone but not enough to reach normal levels. A third group was left untreated.

Compared with the untreated group, the fully treated group had 24% fewer heart attacks, 36% fewer strokes, and 56% lower mortality. Testosterone therapy was highly beneficial.

Over the last twenty years, I have also seen testosterone therapy benefit men with weakness, low sex drive, and depression, despite having blood testosterone levels in the normal range. They have had pronounced improvement in mood, energy and quality of life after treatment. The normal range of male testosterone is broad, from 300-1100 ng/dl. Moving to a higher level, still within the normal range, may be beneficial for men with symptoms of deficiency, including weakness, fatigue, depression, slow healing from injuries, and lower sexual interest or performance.

man2What’s the down side? Testosterone does not cause prostate cancer. However, it can stimulate growth in already existing prostate cancers. We always measure the PSA after 3 months of testosterone therapy and yearly thereafter. Testosterone may also increase the size of the prostate, leading to impaired urine flow. Men should be monitored for changes in urination.

Testosterone can be administered as an oral or sublingual tablet, transdermal cream, intramuscular injection, or pellet implant. Pellets are the strongest method, as they maintain constant blood levels for 4 months, without fluctuation. The procedure is fast, simple, and painless after the injection of a local anesthetic.

For more information, visit

Allan Sosin, MD

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