The question of whether a 60-year-old man should begin testosterone therapy is highly personal and requires careful medical evaluation. As men age, the body naturally experiences a gradual decline in testosterone production, sometimes referred to as late-onset hypogonadism. This decline typically begins around age 30 or 40. Testosterone Replacement Therapy (TRT) is a medical intervention intended for men with a true deficiency, not a simple anti-aging treatment. The decision must be made in consultation with a healthcare provider, weighing potential symptomatic improvement against the specific health risks for this age group.
Identifying the Need for Treatment
A diagnosis of hypogonadism requires both self-reported symptoms and confirmed low laboratory values. Symptoms associated with low testosterone are often non-specific, including persistent fatigue, depressed mood, reduced lean muscle mass, and decreased bone density. More specific signs include a significant reduction in libido and sexual function, such as erectile dysfunction.
Because these symptoms overlap with many other age-related conditions, blood testing is mandatory to confirm a deficiency. The gold standard involves measuring total serum testosterone in the morning, ideally between 8:00 a.m. and 10:00 a.m., when levels are highest. This test should be repeated on a second day to account for the natural fluctuation of the hormone.
The American Urological Association (AUA) uses a total testosterone level below 300 nanograms per deciliter (ng/dL) as the threshold for a low value. If the total level is borderline (e.g., 280 to 400 ng/dL), measuring free testosterone becomes important. Free testosterone is the biologically active hormone available to tissues, offering a more accurate measure, especially in men with obesity. A diagnosis and indication for treatment are established only when both consistent clinical symptoms and low lab values are present.
Potential Benefits of Testosterone Replacement
For a 60-year-old man who is genuinely hypogonadal, TRT can lead to measurable improvements in quality of life. Sexual function is often one of the first domains to benefit, with patients reporting increases in libido and erectile function. This improvement can also contribute to a better overall mood and an enhanced sense of well-being.
Testosterone therapy can positively alter body composition. Men often experience an increase in lean body mass and a reduction in fat mass. This improvement in muscle mass translates to increased muscle strength and power, such as in chest press or stair-climbing performance.
Bone health also benefits from TRT, as testosterone helps maintain bone mineral density, reducing the risk of osteoporosis and fracture. Treatment can lead to increased bone strength and density, particularly in the spine. TRT has also been observed to correct unexplained anemia by stimulating red blood cell production.
Evaluating the Risks for Men Over 60
The most significant consideration for older men initiating TRT involves the potential for adverse health effects, requiring detailed screening and long-term surveillance. A primary concern is prostate health: TRT does not initiate prostate cancer, but it can accelerate the growth of an existing, undetected tumor.
A digital rectal exam (DRE) and a Prostate-Specific Antigen (PSA) test must be performed before starting therapy. During treatment, an increase in PSA of more than 1.4 ng/mL in one year, or a significant rise over two years, warrants an immediate urological evaluation. TRT is strictly contraindicated for any man with a history of breast cancer or active, untreated prostate cancer.
Testosterone therapy can stimulate the production of red blood cells, a condition known as polycythemia. This increase thickens the blood, raising the risk of developing blood clots, stroke, or heart attack. Regular monitoring of the hematocrit level—the volume percentage of red blood cells in the blood—is mandatory, with a target level below 54%.
While early studies raised concerns about TRT increasing cardiovascular events, recent large-scale trials suggest it does not significantly increase the risk of heart attack or stroke in men with low testosterone. However, men with a recent history of heart attack or stroke (within the last three to six months) are advised to delay or avoid TRT. TRT is also known to exacerbate existing Obstructive Sleep Apnea (OSA), a common condition in older, overweight men. Men considering TRT should be screened for OSA, and any existing sleep apnea must be properly managed.
Treatment Modalities and Ongoing Monitoring
Testosterone can be delivered through several methods, each affecting hormone stability and convenience. Intramuscular injections are a common approach but may carry a higher risk of polycythemia. Transdermal options, such as gels or patches, are applied daily and maintain stable hormone levels. Subcutaneous pellets, implanted under the skin every few months, offer a long-acting approach.
Initiating TRT requires strict, ongoing medical monitoring for both efficacy and safety. Blood tests should be performed at frequent intervals: at three, six, and twelve months after starting therapy, and then at least annually. These tests confirm the testosterone level is within the therapeutic range and check the hematocrit and PSA levels. TRT is considered a long-term commitment, and treatment should continue only as long as the benefits clearly outweigh the risks.