To T or Not to T A Baltimore-based fiction writer tells the whole truth about his decision to receive testosterone replacement therapy.

On book tour this summer, I found myself saying in a Q&A in Chicago that yes, I was very much like graduate student Silas Huth, depicted in my latest novel, Love Slaves of Helen Hadley Hall. “At 22, I was an arrogant, insecure slut,” I announced, getting the laugh while forgetting that my 81-year-old mother was in the second row.

Well, it was true then, and it’s true now. Sex is and always has been a crucial component of my life, my work and my marriage. I genuinely don’t understand people for whom sex is a sidebar, a routine, an afterthought or a scheduling issue.

I’ve always mocked Viagra and Cialis print ads, believing that my “nature” requires no assistance. I pity those men, gay or straight, who choke—or fear they will—when push needs to shove. Erectile enhance- ment may be a multibillion dollar industry, but I’m not buying. “Let the dance begin,” I scoff—referencing the Viagra tag—until my husband reminds me that he injects 200 milligrams of testosterone cypionate into one of my glutes (always his choice) every second Thursday.

All men experience a slow decline in testosterone as they age. Those who typically begin testosterone therapy do so to treat fatigue, depression and/or erectile dysfunction issues. According to my doctor, men with HIV and men with diabetes are at a greater risk for a greater than normal drop. In my case, in 1995, at 35, 10 years of living with HIV had depleted my hormone levels. I needed no convincing to begin testosterone therapy when I was statistically set to expire in two years.  After developing a rash from the transdermal T-patch, which was also something of a telltale scarlet letter in the Downtown Athletic Club locker room, I switched to biweekly shots from Nurse Bruscio at Greenspring Station. I was a gym rat then, so my first time on T was good for my mood, my pecs and the veins in my forearms. As an unexpected bonus thrill, the first few postinjection orgasms always bore the intensity and velocity of early adolescence. A man forgets these things.

I had stopped the shots by 1998, because, after a year on life-saving antiretroviral drugs, tests showed I had begun producing enough testosterone on my own again. And yet, not quite enough to suit me. Imagine a stalk of celery on its third week in the crisper. To get its crunch back, it needs that upright soak in a glass of water. I began to fret about less-than-complete power surges at crucial junctures on third dates. Enter Steve, a divorced father of six, a nurse and, metaphorically speaking, a very tall glass of water. (He is now my husband.)

Love means you can drop your gym membership. For more than a decade, everything crunched brilliantly while Steve and I whittled down our mortgage and upgraded our furniture. Then, in February of 2013, a testosterone check showed I had a level of 288 nanograms per deciliter. (Medical standards place the average range from 350-900 ng/dcl.) Talking it out with my doctor, I realized that while I still thought and wrote about sex all the livelong day, morning wood had ceased and actual activity had slackened, a development that Steve had been too much of a gentleman to even mention.

It remains controversial and not entirely settled in the medical establishment as to whether replacing testosterone increases a man’s risks for heart disease and prostate cancer. Yet among my doctor’s current roster of T patients are a man whose cardiologist cleared him to start therapy three months after a cardiac stent and a man who beat prostate cancer 10 years ago. Should I go back on the shots? Or try Axiron, the newfangled underarm gel? (Patches remain an option, at least on the internet.) The stakes had changed for me in 15 years. I had a normal life expectancy now, plus a prostate swollen with its own hopes and dreams, not to mention a male family history riddled with heart fatalities.

Adult acne, another potential side effect, didn’t worry me, but I was psychologically disturbed by the realization that if I went back on T, this time I would stop producing my own. This time, it was hormone replacement. Once begun, I would be getting shots and morning wood until the day I died. Thoughts of a second, biweekly prescription challenged my ideas of manhood in a way that decades of daily blood pressure, heart aspirin, statins and HIV meds did and do not. On the one hand, I might never experience impotence, but on the other hand, I might never experience impotence, which I believe is as a man’s birthright, or at the very least, a fresh subject for my writerly senescence. Think King Lear, or Big Daddy Pollitt in “Cat on a Hot Tin Roof,” or one of Shaw’s greatest creations —hold for the name—Captain Shotover in “Heartbreak House.”

It didn’t take long for this arrogant, insecure slut of 52 to rule, as ever, in favor of more sex. Today, after three years, Steve and I are pretty good at remembering that the Thursdays in the weeks that the cleaning lady doesn’t come on Mondays are shot nights. At last count, my T level was 899, and my mood is good, even if my arms are flabby. The gym beckons, but let’s not get crazy.

So, gentlemen of my vintage: Think about it. There’s no harm—or loss of manhood—in broaching the subject; my doctor says that less than 10 percent of his male patients between 40 and 60 ask about testosterone therapy. Weigh the risks and benefits with your medical team, which may or may not include your spouse, cardiologist and urologist. Most insurance plans will cover the treatment.

Some final practical advice: The needle is big, but you don’t have to look at it. The glute may feel a little sore the following day. I used Axiron gel when I was living in Africa for a year, but I found it messy to apply, hard to measure and slow to dry. Plus, if it drips onto your grandchildren, they’ll grow pubic hair wherever it lands. As to the most important question of all—“Will prescribed testosterone make my balls shrink?” The answer is, unfortunately, “Probably not, but there is no guarantee.” Mine have not.

Thus far.

James Magruder has been living, and oversharing, in Baltimore for almost 25 years.

Illustration by Matthew Daley.