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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is male hormone replacement therapy needed for a 68 year old man having mid level blood testosterone levels and low libido?

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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 105 Questions

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Posted on Fri, 17 Aug 2018 in Men's Health
Question: Is male hormone replacement needed for a 68 yr old man w a mid level blood testosterone. He suffers from lack of libido. Thank you
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Answered by Dr. Bonnie Berger-Durnbaugh 1 hour later
Brief Answer:
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Detailed Answer:
Hello and Welcome to ‘Ask A Doctor’ service.

If his testosterone level falls in the normal range, I would not recommend supplementing it. Increasing testosterone from exogenous sources can cause the pituitary to tell the testes (via less gonadotropic releasing hormone) to make less testosterone, so it can be counter productive after awhile. Also, testosterone in excess can cause a number of bad side effects on the body.

There are other causes of low libido beyond low testosterone, which it sounds like your husband doesn't have.

These can include the following:
1. Obesity
2. Medications that he may be taking for health problems. This includes medication for hair loss too.
3. Psychological disinterest, depression and anxiety, and excess alcohol.
4. Low levels of other hormones including dopamine or thyroxine (thyroid hormone).
5. Diabetes or poorly controlled blood sugar.
6. High blood pressure that isn't well controlled.
7. High cholesterol.

So if he hasn't already, he should see his primary doctor and/or a urologist to discuss the problem.

I hope this information helps. Please let me know if I can provide further information.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 21 hours later
Dr Dumbaugh-Thank you. I have mild peyronies and have a below average erection and I think this may affect my libido. I have none of the 7 items mentioned. Viagra only works fair. Do you have suggestions?
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Answered by Dr. Bonnie Berger-Durnbaugh 1 hour later
Brief Answer:
Information/suggestions

Detailed Answer:
If you have mild Peyronie's disease, this would be the time to have it assessed and consider possible treatments as it can evolve and worsen. And yes, having Peyronie's can interfere with libido as you are suspecting, particularly if it is uncomfortable. There are a number of treatments that range from alternative (supplements) to medications, to surgery. The research itself on these non-surgical treatments has been of somewhat poorer quality, unfortunately. But there are non-surgical treatments that may help. I'm listing those treatments and the associated information on them below. The main non-surgical way of treating mild Peyronie's is with Pentoxifylline, both orally and with injections along with physical therapy (traction).

For treatment of the Peyronie's, you will need to see a urologist as primary care doctors don't have adequate experience with this.

Regarding surgical treatment, it can be considered when Peyronie's disease has persisted for more than 12 months and is interfering with sexual function. Surgery is delayed until Peyronie's disease has been stable for at least three months because active disease can affect the surgical outcome.

Surgery is not indicated for plaque without curvature, or for people with minimal degrees of curvature, though "minimal degree" is a subjective measurement. The main thing determining this is whether sexual intercourse without pain (for patient or partner) is possible.

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In case you are interested in more reading on what is being used and why, here is the most recent information from the physician digest "UpToDate" on Pentoxifylline, Vitamin E, and other medical (non-surgical) treatments:

Encouraged by pentoxifylline's observed suppression of collagen production in Peyronie's cells in tissue culture, as well as its efficacy in other human fibrotic disorders, we have been offering patients treatment with pentoxifylline as a treatment option for PD since 2002. The earliest meaningful improvement in degree of curvature may take four months or more. The patient may be reassessed in four- to five-month intervals. If interval improvement is observed, pentoxifylline may be continued up to two years.

An article comparing (nonrandomized or blinded) pentoxifylline to vitamin E demonstrated significant improvement/stability in ultrasonographic calcifications (92 versus 44 percent) and decreased subjective worsening of the curvature (25 versus 78 percent).

Vitamin E — Vitamin E is a potent antioxidant that is thought to reduce collagen deposition within the injured tunica albuginea. Although Vitamin E is a widely used agent for PD in the United States, there is little evidence to support its superiority over placebo.

By contrast, vitamin E was effective in men with mild curvature when used in combination with colchicine.

Carnitine — Carnitine supplements have shown mixed results in comparison to other medications or placebo.

Intralesional drug therapy — Intralesional drug injections are generally safe and well-tolerated. There are three intralesional drug treatments that have shown efficacy in randomized trials: verapamil, interferon alfa-2b, and collagenase. We typically use intralesional injection in conjunction with oral pentoxifylline and physical therapy (traction) to treat PD patients with moderate deformity (30 to 90 degree curvature) and an intact erection.

Most but not all studies have shown improvement in symptoms and penile plaque/curvature with intralesional verapamil therapy. Verapamil injection is safe, well-tolerated, and commonly used as part of nonsurgical PD management.

Interferon alfa-2b — Limited clinical evidence suggests that interferon alfa-2b treatment may be efficacious for mild to moderate PD. Interferon injections appear safe, with a primary side effect of flu-like symptoms in some patients.

Collagenase — Collagenase, a purified bacterial enzyme targeting collagen for breakdown, improves penile curvature when injected intralesionally.

OTHER TREATMENTS — Penile traction, iontophoresis, extracorporeal shockwave therapy (ESWT), and radiation therapy are other treatment approaches to Peyronie's disease (PD), but none have been shown to be conclusively effective in randomized trials. Well-designed studies are needed to document a treatment effect, should it exist, prior to widespread use.

Penile traction therapy — Penile traction therapy, usually in conjunction with medical management, has shown some efficacy with a favorable safety profile in small case studies. In a study of 10 men with PD, nine of whom had failed medical therapy, traction for two to eight hours a day for six months led to reduced curvature in all men (10 to 45 degrees), increased stretched flaccid penile length (0.5 to 2.0 cm), and increased erect girth (0.5 to 1.0 cm). There were no adverse events. Further studies have demonstrated that traction in conjunction with oral agents and injection therapy may improve curvature and stretched penile length to a modest degree, although the data have been mixed. Traction may also confer a positive effect on patient outcomes after reconstructive surgery.

Iontophoresis — Several reports have investigated the effect of electromotive drug administration, also known as iontophoresis. Theoretically, electrokinetic transport of charged ionic molecules may enhance the delivery of transdermal medications to the target tissues, in this case the diseased tunica albuginea, thereby improving local penetration without systemic side effects. Increased levels of verapamil were present after iontophoresis in surgically retrieved tunica albuginea specimens.

Iontophoresis is well-tolerated, with the most common side effect being temporary erythema at the electrode site. If iontophoresis continues to prove efficacious, widespread acceptance of iontophoresis likely would occur since it can readily be performed at home.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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