Hormonal Changes in Older Men

What hormonal changes do older men have?

Men have less testosterone, the male hormone, as they get older. This may cause problems with erections or less interest in sex.

As men grow older, many continue to have active, enjoyable sexual lives. However, some men find the quickness and intensity of their sexual responses have decreased. You may notice that:

• Erections during sleep and at the time of waking are less frequent.
• It takes longer to have an erection and it is usually less rigid.
• Erections are more easily lost.
• Ejaculation is less forceful and may become seepage.

How is reduced testosterone found and treated?

The level of testosterone in your body can be measured with a blood test. If your level of testosterone is low, your healthcare provider may prescribe testosterone replacement therapy (TRT). You do not have to take replacement treatment. Treatment can improve erections and sexual performance. Other possible benefits of treatment (effects on bone and muscle mass) are mild or not well proven. However, TRT has risks, too, such as possibly increasing your chances of having trouble with prostate cancer.

Testosterone replacement therapy is available as shots, patches, or gels. Pills have fallen out of favor with experts. Talk to your healthcare provider about which preparation to try. Also, check your insurance coverage and co-pays for the different treatments.

TRT may not be right for you if you have high cholesterol, heart disease, or are at risk for prostate cancer. TRT may enlarge the prostate or increase your risk for prostate cancer. Take testosterone only if your healthcare provider approves. Men taking testosterone should be examined for signs of a tender or enlarged prostate. If you have a family history of prostate cancer, you may want to have a PSA (prostate specific antigen) test.

What about DHEA (dehydroepiandrosterone)?

DHEA is a close relative of testosterone. In the body, DHEA is turned into testosterone and related hormones, but it also is turned into estrogens. As a result, DHEA has a mix of male and female hormonal effects. It is a popular supplement in health food stores, but the quality control of the contents of the products varies. Most of the claims on antiaging effects of DHEA have not been proven in good medical studies. Studies of dementia, overall well-being, muscle size and strength, body fat composition, or bone density show either no effect or very small, not very helpful, effects. Studies do show that DHEA usually lowers the "good" cholesterol--that is, HDL--in most people. Good studies on how DHEA might affect the prostate or heart disease have not been done. Given this body of evidence, many healthcare providers do not recommend DHEA supplements.