Dear Dr. Roach: I am a 67-year-old male in fair to good health (more good than fair, really). In a recent column, you mentioned that a good testosterone level for a man taking a replacement would be between 500-600 ng/dl.

In November, I was tested for my testosterone level. At the time, I was (and still am) suffering from a low sex drive and erectile dysfunction. My level was 290 ng/dl. The reference range my primary care doctor bases his judgment on has an acceptable range from 193-950 ng/dl; hence he said my level was low normal.

When looking at the symptoms of low testosterone, I noted that I have at least four symptoms: low sex drive, ED (for which I have already been treated with a prosthetic implant), loss of body hair (especially my legs) and, most notably, osteoporosis (for which I take alendronate sodium, 70 mg weekly). I was diagnosed in November.

I also am being treated for depression and anxiety disorder, and have been since 2001. I dont know if this is related to my testosterone level.

Should I talk to my doctor about the disparity Ive found in reference ranges? Should I be seeking treatment for the low testosterone? J.P.P.

Answer: I think you definitely should speak to your primary care physician. You also might benefit from a discussion with a urologist or endocrinologist with experience in treating men with testosterone replacement.

When we look at normal testosterone levels by age, we find that older men have lower normal levels; however, given your symptoms and result, I certainly would think a trial of testosterone would be appropriate. I must say that I am surprised that you had an implant placed without a trial of testosterone first. I also am surprised you were treated for osteoporosis without a trial of testosterone replacement, which has been shown to improve bone density in men with low testosterone levels (one study treated men with a testosterone level below 350; another if they were below 320). Low libido and erectile dysfunction both frequently respond to testosterone replacement: Some men get benefit in their mood as well. You sound to me like an excellent candidate for testosterone replacement.

Dr. Roach writes: A recent column from a man asking for alternatives to coronary bypass surgery generated many letters with the same question: Why not advise a change in diet as an alternative to surgery?

There are two reasons. The first is that its not an alternative to surgery: Its a medical recommendation that should be made for every person with diagnosed coronary disease. Nearly all people can improve their diet. While a vegan diet was the most common recommendation I received, it still is not clear that a vegan diet is most likely to reduce coronary disease. In the vast literature on diet, there are only a few well-done studies that show a benefit. The clearest benefit has been from the Mediterranean diet, but a very-low-fat, plant-based diet, in combination with stress reduction and smoking cessation, has been shown to help reverse coronary lesions.

The second reason is that if someone needs the arteries in his or her heart reopened, the changes in diet are not likely to reverse blockages in the time needed to prevent a heart attack.

Healthy diet changes are appropriate for all people with heart blockages, but inadequate by themselves in the short term, in people with symptoms of angina and serious blockages.

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Dr. Keith Roach is a syndicated columnist with North America Syndicate Inc., P.O. Box 536475, Orlando, FL 32853-6475.

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