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You may also need medication or other therapy for difficulty getting or maintaining erections. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.

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Men's Health Is testosterone therapy safe? Take a breath before you take the plunge August 29, Ask your doctor to explain the various side effects for the different formulations of testosterone. The different treatments include testosterone injections, gels and patches.

Know what to look for if something goes wrong. Print This Page Click to Print. Staying Healthy. Men's Health. Free Healthbeat Signup Get the latest in health news delivered to your inbox! Goal is to increase level to midnormal range, although there is no clear target level. Endocrine Society recommends levels between and ng per dL Of note, there is no consensus on the necessity and timing of repeated PSA testing and digital rectal examination for men on testosterone therapy.

Although the Endocrine Society and a multidisciplinary Canadian panel recommend annual PSA and digital rectal examination screening in men 40 years and older, 9 , 11 the U. Preventive Services Task Force recommends against routine PSA screening and does not specify its recommendation on digital rectal examination.

Most experts agree that the goal serum testosterone level should be in the midnormal range i. In February , the first results from the Testosterone Trials sponsored by the National Institutes of Health were published. Results of the trials assessing cognitive function, anemia, bone density, and cardiovascular health are forthcoming. However, the Testosterone Trials were designed to assess only effectiveness and not the risks of testosterone therapy, including prostate cancer or cardiovascular disease.

In women, testosterone is produced by the ovaries and adrenal glands, and by conversion of proandrogens in peripheral tissues. Levels decrease gradually starting in the 20s or 30s. There is no abrupt decrease during menopause, with the exception of surgical menopause.

A comprehensive meta-analysis of post-menopausal women found improvement in sexual function with testosterone therapy. There was no evidence of improvement in anxiety, mood, body weight or mass, or bone density. The use of testosterone therapy in women is summarized in Table 6.

Diagnosis is clinical; there is no established cutoff level of testosterone to indicate treatment. There are no formulations readily available in the United States that provide the recommended treatment dosage for women mcg per day , necessitating the use of compounding pharmacies. Adverse effects may include virilization acne, hirsutism, deepening of the voice and adverse lipid changes; the effect of testosterone on breast and endometrial tissue is not well studied, although there is currently no evidence of cancer risk.

Treatment should begin with a six-month trial period, and continued only if the patient is responding favorably at that time; there are no safety and effectiveness data beyond 24 months. Information from references 64 and Testosterone therapy may also be used to facilitate gender transition for transgender men and gender nonbinary individuals desiring masculinization.

Primary care physicians are increasingly involved in the initiation and management of testosterone therapy for this population. This article updates a previous article on this topic by Margo and Winn. Data Sources: PubMed, Essential Evidence Plus, the Cochrane database, and the National Guideline Clearinghouse were searched using the key term testosterone, alone and with cardiovascular, cognition, sexual function, bone density, strength, depression, risk, benefit, and adverse event.

Reference lists from the included meta-analyses were reviewed for potential sources. Search dates: November 30, ; January 15, ; February 10, ; and March 17, Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Ryan C. Reprints are not available from the authors.

Food and Drug Administration. September 17, Accessed March 11, PS3— testosterone replacement therapy patterns for aging males in a managed care setting.

Clin Med Res. Carnegie C. Diagnosis of hypogonadism: clinical assessments and laboratory tests. Rev Urol. Seftel A.

Male hypogonadism. Part II: etiology, pathophysiology, and diagnosis. Int J Impot Res. Male hypogonadism in systemic disease. Endocrinol Metab Clin North Am. Systematic literature review of the epidemiology of nongenetic forms of hypogonadism in adult males. J Hormones. Accessed March 3, Pain Physician. Basaria S. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. Clin Endocrinol Oxf.

Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline. PLoS One. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. Effects of testosterone treatment in older men. N Engl J Med. Effects of testosterone supplementation on depressive symptoms and sexual dysfunction in hypogonadal men with the metabolic syndrome.

J Sex Med. Diabetes Care. Effect of testosterone treatment on constitutional and sexual symptoms in men with type 2 diabetes in a randomized, placebo-controlled clinical trial.

Synergetic effect of testosterone and phophodiesterase-5 inhibitors in hypogonadal men with erectile dysfunction: a systematic review. Can Urol Assoc J. American Urological Association: ten things physicians and patients should question. February 21, Accessed September 5, Association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis.

Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailty. J Am Geriatric Society. Effect of testosterone treatment on volumetric bone density and strength in older men with low testosterone: a controlled clinical trial JAMA Intern Med. Effects of testosterone and progressive resistance exercise in healthy, highly functioning older men with low-normal testosterone levels. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study.

Clinical meaningfulness of the changes in muscle performance and physical function associated with testosterone administration in older men with mobility limitation. A systematic review of augmentation strategies for patients with major depressive disorder. Psychopharmacol Bull. Androgen treatment of depressive symptoms in older men: a systematic review of feasibility and effectiveness. Can J Psychiatry. Testosterone and depression: systematic review and meta-analysis.

J Psychiatr Pract. Parallel-group placebo-controlled trial of testosterone gel in men with major depressive disorder displaying an incomplete response to standard antidepressant treatment. J Clin Psychopharmacol. Effects of testosterone on cognition and mood in male patients with mild Alzheimer disease and healthy elderly men. Arch Neurol. Effects of transdermal testosterone on cognitive function and health perception in older men with low bioavailable testosterone levels.

Effects of long-term testosterone administration on cognition in older men with low and low-to-normal testosterone concentrations: a prespecified secondary analysis of data from the randomised, double-blind, placebo-controlled TEAAM trial. Lancet Diabetes Endocrinol. Effect of long-acting testosterone undecanoate treatment on quality of life in men with testosterone deficiency syndrome: a double blind randomized controlled trial.

Asian J Androl. Testosterone replacement therapy with long-acting testosterone undecanoate improves sexual function and quality-of-life parameters vs. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels: a randomized clinical trial.

FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. March 3, Accessed March 12, Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels [published correction appears in JAMA.

Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med. Adverse events associated with testosterone administration. Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clinic does not endorse companies or products.

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Healthy Lifestyle Sexual health. Products and services. Testosterone therapy: Potential benefits and risks as you age Considering testosterone therapy to help you feel younger and more vigorous as you age?

By Mayo Clinic Staff. Open pop-up dialog box The influence of testosterone in men Close. The influence of testosterone in men The male hormone testosterone plays an important role in the development and maintenance of typical masculine physical characteristics, such as muscle mass and strength, and growth of facial and body hair.

Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Please try again. Something went wrong on our side, please try again. Show references Qaseem A, et al.

Testosterone treatment in adult men with age-related low testosterone: A clinical guideline from the American College of Physicians. Annals of Internal Medicine. Male hypogonadism adult. Mayo Clinic; Gilbert K, et al. Gaps in patient knowledge about risks and benefits of testosterone replacement therapy.