Testosterone Replacement Therapy
What is Testosterone?
Testosterone is the male sex hormone made in the testicles
Testosterone hormone levels are important to normal male sexual development and functions
This hormone helps boys develop male features like body and facial hair, a deeper voice and muscle strength. Also, men need testosterone to make sperm
What is Low Testosterone?
Some men have low testosterone levels. This is called Testosterone Deficiency Syndrome
Andropause or late-onset hypogonadism is a common disorder which increases in prevalence with advancing age
What are the possible symptoms of Testosterone Deficiency?
Physical Symptoms and Signs
Reduced energy
Reduced endurance
Diminished work performance
Diminished physical performance
Loss of body hair
Reduced beard growth
Fatigue
Reduced lean muscle mass
Obesity
Cognitive Symptoms and Signs
Depressive symptoms
Cognitive dysfunction
Reduced motivation
Poor concentration
Poor memory
Irritability
Sexual Symptoms and Signs
Reduced sex drive
Reduced erectile function
None of these signs or symptoms are specific to low testosterone
What can cause Testosterone Deficiency?
Aging
Obesity (being overweight)
High blood pressure or high blood sugar
Infection
Autoimmune diseases
Injury to the testicles by accident/removal of testicles (because of disease)
Chemotherapy or radiation
Opioid use or other medication
How will my doctor know for sure that I have Testosterone Deficiency?
Perform a physical exam and complete a medical history to include any diseases and medications you take
Order blood tests to check your testosterone level
The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs
Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone
The diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion
Order other tests such as hormone tests
In patients with low testosterone, clinicians should measure serum luteinizing hormone levels
Patients with persistently high prolactin levels of unknown etiology should undergo evaluation for endocrine disorders
What is the Treatment for Testosterone Deficiency?
All men with testosterone deficiency should be counseled regarding lifestyle modifications as a treatment strategy
Lifestyle changes:
Exercise
Diet/weight loss
Sleep hygiene
You also may benefit from Testosterone Replacement Therapy (TRT).
What are the potential benefits of Testosterone Replacement Therapy?
There are many benefits associated with Testosterone Replacement Therapy including;
Testosterone therapy may result in improvements in erectile function, low sex drive, anemia, bone mineral density, lean body mass, and/or depressive symptoms
Clinicians should inform testosterone deficient patients that low testosterone is a risk factor for cardiovascular disease
Although evidence is inconclusive and studies are ongoing, testosterone therapy has been linked to improved cognitive function, measures of diabetes, energy, fatigue, lipid profiles and quality of life measures.
There are usually five different ways to take testosterone
Transdermal (through the skin)
Injection
Oral/buccal (by mouth)
Intranasal (through the nose)
Pellets under the skin
Frequently Asked Questions
Are there any harmful effects of Testosterone Replacement Therapy?
Yes, Testosterone Therapy may have some harmful effects and needs monitoring
Prior to offering testosterone therapy, clinicians should measure hemoglobin and hematocrit and inform patients regarding the increased risk of polycythemia
PSA should be measured in men over 40 years of age prior to commencement of testosterone therapy to exclude a Prostate Cancer diagnosis
The long-term impact of exogenous testosterone on spermatogenesis should be discussed with patients who are interested in future fertility
Is it true that TRT may cause Prostate Cancer?
Clinicians should inform patients of the absence of evidence linking testosterone therapy to the development of Prostate Cancer
Patients with testosterone deficiency and a history of Prostate Cancer should be informed that there is inadequate evidence to quantify the risk-benefit ratio of testosterone therapy
Does TRT cause vein clots or heart disease?
At present, there is no reason to believe that TRT causes vein clots. Also, there is no strong evidence that TRT either increases or lessens the risk of cardiovascular events. However, while you are on TRT, you should call your doctor right away if you have signs or symptoms of stroke or heart attack.
Can Testosterone Replacement Therapy cause infertility?
The long-term impact of exogenous testosterone on spermatogenesis should be discussed with patients who are interested in future fertility
Is TD a common medical condition?
It is hard to know how many men have TD
Overall, about 2.1% (about 2 men in every 100) may have TD. As few as 1% of younger men may have TD, while as many as half of all men over 80 years old may have TD
TD is more common in men who have diabetes or who are overweight. If you are overweight, try to work on keeping your weight within recommended ranges
Getting more exercise may help you lose weight and also may help your testosterone levels
I think I may have Testosterone Deficiency. Is Testosterone the answer for me?
You may need Testosterone Therapy, but it may or may not be the best treatment for you
TD comes naturally as you grow older and there may be other reasons for TD levels
You should not be taking TRT if you do not have low testosterone levels
If your blood testosterone is low, then your doctor will give you a full exam to assess what is the best treatment for you and whether you may be helped by TRT
How will I know the testosterone therapy is working?
During treatment, you will need routine checkups to see that your testosterone level stays normal. When you are stable on TRT, total testosterone and certain other lab tests should be checked every 6-12 months.