From the Guidelines
Yes, getting your testosterone levels checked is a reasonable step if you're experiencing persistent fatigue at 51 years old. Testosterone naturally declines with age, and low levels can cause fatigue, reduced energy, decreased muscle mass, and mood changes. The evaluation should include a comprehensive blood panel measuring both total and free testosterone, preferably drawn in the morning when levels are highest 1. However, fatigue has many potential causes including sleep apnea, thyroid disorders, depression, and other medical conditions, so a complete evaluation is important.
Testosterone Replacement Therapy (TRT) Risks and Benefits
Regarding testosterone replacement therapy (TRT), the risks include potential cardiovascular complications (increased risk of heart attack or stroke in some men), sleep apnea, acne, breast enlargement, testicular shrinkage, reduced sperm production, and possible stimulation of existing prostate cancer 1. Benefits typically include improved energy, libido, mood, and muscle mass. If prescribed, TRT comes in several forms including injections (typically 50-100mg weekly), daily gels (AndroGel, Testim), patches, or pellets implanted every 3-6 months.
Monitoring and Recommendations
Regular monitoring of testosterone levels, prostate-specific antigen (PSA), hematocrit, and cholesterol is essential during treatment to minimize risks and optimize benefits 1. The American College of Physicians suggests that clinicians discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual function, and reevaluate symptoms within 12 months and periodically thereafter 1.
Key Points to Consider
- Testosterone levels should be checked in the morning when levels are highest.
- A comprehensive evaluation is necessary to rule out other causes of fatigue.
- TRT may improve sexual functioning and quality of life, but long-term efficacy and safety are unknown.
- Regular monitoring is crucial to minimize risks and optimize benefits.
- The decision to initiate TRT should be made after discussing potential benefits and harms with a clinician.
From the FDA Drug Label
In patients with breast cancer and in immobilized patients, androgen therapy may cause hypercalcemia by stimulating osteolysis. Geriatric patients treated with androgens may be at an increased risk for the development of prostatic hypertrophy and prostatic carcinoma There have been postmarketing reports of venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), in patients using testosterone products, such as testosterone enanthate injection. Long term clinical safety trials have not been conducted to assess the cardiovascular outcomes of testosterone replacement therapy in men To date, epidemiologic studies and randomized controlled trials have been inconclusive for determining the risk of major adverse cardiovascular events (MACE), such as non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death, with the use of testosterone compared to non-use Some studies, but not all, have reported an increased risk of MACE in association with use of testosterone replacement therapy in men.
Testosterone Level Check: It is not explicitly stated in the provided drug labels whether you should get your testosterone levels checked at 51 years old for persistent fatigue.
Risks of Testosterone Therapy: The risks of testosterone therapy include:
- Venous Thromboembolic Events: Deep vein thrombosis (DVT) and pulmonary embolism (PE) have been reported in patients using testosterone products.
- Cardiovascular Risks: The risk of major adverse cardiovascular events (MACE) is inconclusive, but some studies have reported an increased risk.
- Prostatic Hypertrophy and Carcinoma: Geriatric patients may be at an increased risk for the development of prostatic hypertrophy and prostatic carcinoma.
- Hypercalcemia: Androgen therapy may cause hypercalcemia by stimulating osteolysis in patients with breast cancer and in immobilized patients. 2
From the Research
Fatigue and Testosterone Levels
- Fatigue is a common symptom that can be caused by various factors, including lifestyle issues, physical conditions, mental disorders, and treatment side effects 3, 4.
- At 51 years old, it is possible that low testosterone levels could be contributing to fatigue, but it is essential to rule out other potential causes.
- The studies provided do not directly address the relationship between testosterone levels and fatigue in men at this age group.
Risks of Testosterone Therapy
- Testosterone replacement therapy (TRT) can have various risks and side effects, including increases in estradiol, hematocrit, and prostate-specific antigen (PSA) levels 5.
- Different forms of TRT, such as intramuscular testosterone cypionate (IM-TC) and subcutaneous testosterone enanthate (SCTE), may have varying effects on these levels 5.
- One study found that SCTE was associated with lower post-therapy estradiol and hematocrit levels compared to IM-TC 5.
- Another study found that chronic testosterone cypionate therapy can suppress serum luteinizing hormone (LH) levels and improve libido and potency in impotent men with low testosterone levels 6.
Evaluation and Management of Fatigue
- A comprehensive history and physical examination are crucial in evaluating and managing fatigue 3, 4.
- Laboratory studies may not always be necessary, and repeat testing is generally not indicated if initial results are normal 3.
- Treatment of fatigue should include a structured plan for regular physical activity, such as walking, and may involve cognitive behavior therapy, exercise therapy, and acupuncture 4.
- It is essential to address underlying conditions and comorbidities that may be contributing to fatigue 4.