Testosterone therapy for men over 85 is a complex topic that requires careful consideration of benefits, risks, and individual health status. Testosterone levels naturally decline with age, and some older men experience symptoms like reduced sexual function, decreased muscle mass, fatigue, and lower quality of life that may be linked to low testosterone. Testosterone replacement therapy (TRT) aims to restore testosterone to more youthful levels, potentially improving these symptoms. However, the safety and appropriateness of TRT in men over 85 must be evaluated cautiously.
For men over 85, **testosterone therapy can be safe when individualized and carefully monitored**. The therapy has been shown to improve sexual desire, erectile function, muscle strength, bone density, insulin sensitivity, and overall vitality in older men with clinically low testosterone levels. These benefits often translate into better physical function and quality of life. Importantly, most benefits are observed when testosterone levels are brought to a moderate target range rather than excessively high levels. This careful dosing helps minimize risks.
Regarding safety, **major concerns historically included cardiovascular risks and prostate health**. However, recent evidence suggests that when TRT is prescribed following clinical guidelines and contraindications are respected, it does not significantly increase the risk of heart attacks, strokes, or prostate cancer in older men. The most common side effect is erythrocytosis, an increase in red blood cell count, which can be managed by adjusting the dose or temporarily stopping therapy. Regular monitoring of hematocrit levels, prostate-specific antigen (PSA), and cardiovascular health is essential to detect and address any adverse effects early.
Men over 85 often have multiple health conditions and take various medications, which makes **individualized assessment critical** before starting TRT. Doctors typically evaluate baseline testosterone levels, symptoms, prostate health, cardiovascular status, and overall frailty. TRT is generally avoided in men with active prostate cancer or severe heart disease. For those who are suitable candidates, ongoing follow-up is necessary to ensure therapy remains safe and effective.
Alternative hormone therapies that stimulate the body’s own testosterone production or modulate hormone balance may also be considered, especially if fertility or other specific concerns exist. These options tend to have fewer side effects but require close hormonal monitoring.
In summary, testosterone therapy in men over 85 can be safe and beneficial if carefully prescribed and monitored. It is not a one-size-fits-all treatment and should be approached with caution, respecting individual health profiles and potential risks. When done properly, TRT can improve symptoms related to low testosterone and enhance quality of life without significantly increasing serious health risks.
