- Male hypogonadism: More than just a low testosterone
- What is Low Testosterone?
- How Do I Take Testosterone?
- Are There Side Effects of TT?
- Low Testosterone: How Low Can It Go?
- How Low Can Testosterone Go?
- When to Talk With Your Doctor About Low T
- Low Testosterone
- The Men’s Clinic at UCLA – Low Testosterone / Hypogonadism
- Treating low testosterone levels
- Men naturally lose testosterone as they age, but there are “low-t” treatments available.
Male hypogonadism: More than just a low testosterone
Editor’s note: This article on the differential diagnosis of hypogonadism in men is the first of two articles. The second, to be published next month, focuses on the appropriate use of testosterone therapy.
A 54-year-old man is referred for evaluation of low testosterone. He had seen his primary care physician for complaints of diminished libido and erectile dysfunction for the past year and worsening fatigue over the past few years. He has not been formally diagnosed with any medical condition. His serum testosterone level is 180 ng/dL (reference range 249–836 ng/dL).
On physical examination, he is obese (body mass index 31 kg/m2) with a normal-appearing male body habitus, no gynecomastia, and normal testicles and prostate gland.
How should this patient be evaluated?
LOW TESTOSTERONE HAS MANY CAUSES
Male hypogonadism, ie, failure of the testes to produce adequate amounts of androgen or sperm, has become a common clinical finding, particularly in the older population. This is more likely the result of an increase in awareness and detection of the disorder by physicians rather than a true increase in prevalence.
The finding of a low serum testosterone value needs to be confirmed and thoroughly evaluated before starting treatment. It is important to determine whether the cause is a primary (hypergonadotropic) testicular disorder or secondary to a hypothalamic-pituitary process (hypogonadotropic or normogonadotropic).
THE HYPOTHALAMIC-PITUITARY-GONADAL AXIS
Testosterone production is under the control of luteinizing hormone (LH), whereas sperm production is under the control of follicle-stimulating hormone (FSH) (Figure 1). Both of these pituitary hormones are regulated by the pulsatile secretion of hypothalamic gonadotropin-releasing hormone (GnRH).
Testosterone (produced by Leydig cells) and inhibin B (produced by Sertoli cells within the seminiferous tubules) result in negative feedback inhibition of gonadotropin (LH and FSH) secretion. Testosterone and estradiol (produced by aromatization of testosterone) act at both pituitary and hypothalamic sites and are the principal regulators of LH secretion.1,2 Inhibin B is the major regulator of FSH secretion in men,3 but steroid feedback also occurs.2,4
TO FOLLOW UP A LOW TESTOSTERONE, CONFIRM THE VALUE NEAR 8 am
If a testosterone value is found to be low, it is important to determine the time that the sample was obtained. Serum testosterone levels follow a diurnal rhythm, at least in younger men, with values near 8 am being, on average, 30% higher than the trough levels later in the day.5–7 The timing of the diurnal variation may be different in night-shift workers, who may require assessment at a more appropriate time of the day (ie, upon awakening).
Another factor affecting testosterone levels is the patient’s health status at the time of testing. Values obtained in the hospital during an acute illness should be repeated once the event has resolved, as testosterone values decrease considerably in this setting.8 Even in outpatients, particularly in men over age 60, one must be sure that the low testosterone level was not obtained during a period of decompensation of one of the many comorbidities seen in these patients, such as coronary artery disease, congestive heart failure, or uncontrolled diabetes.
If an 8 am testosterone value is low, it is reasonable to obtain at least one confirmatory testosterone level on another day, near 8 am, in the next few weeks, when the patient is in good health. Confirming the testosterone level is important, particularly since commercially available testosterone assays are not well standardized and some are frankly unreliable.9,10 A repeat confirmatory level should always be performed by a reliable reference laboratory. If the testosterone level is still low, further evaluation is warranted.
TOTAL TESTOSTERONE VS BIOAVAILABLE TESTOSTERONE VS FREE TESTOSTERONE
Of the total circulating testosterone, 60% is bound to sex hormone-binding globulin (SHBG), 38% is bound to albumin, and only 2% is free. All of these fractions can be measured to assess for testosterone deficiency.
Free testosterone is the biologically active form of this hormone and, thus, the free testosterone level is considered to be a better representation of the true testosterone status. However, some clinicians believe that bioavailable testosterone (testosterone loosely bound to albumin + free testosterone) is a better reflection of the true level of the active hormone than the level of free testosterone alone.
There are situations in which the total testosterone level is low but bioavailable or free testosterone levels are normal. The level of total testosterone is affected by alterations in the levels of SHBG and albumin. A reduction in the level of SHBG can result in low total serum testosterone levels in patients with obesity or type 2 diabetes (states of insulin resistance), and also in cachexia, malnutrition, advanced cirrhosis, acromegaly, hypothyroidism, and nephrotic syndrome. SHBG can also be low in patients taking glucocorticoids, progestins, or androgenic steroids.11 In these settings, checking the level of free testosterone (the active hormone), bioavailable testosterone, or both, by a reliable reference laboratory, may be more appropriate.9,10
But regardless of which measurement is chosen, all testosterone levels—especially bioavailable and free testosterone values—should be interpreted with caution if they are not measured at a reliable reference laboratory.9,10 Interested readers may wish to see the US Centers for Disease Control and Prevention (CDC) Hormone Standardization Program Web site (www.cdc.gov/labstandards/hs.html) for more details, including a list of CDC-certified laboratories.
Men with low testosterone levels after age 40 have a higher risk of death over a four-year period than those with normal levels of the hormone, a new study suggests.
It’s not clear, however, if the two are directly related, and researchers say that it’s possible a third unknown factor is responsible for both low testosterone levels and increased mortality.
The study, led by Molly Shores of the VA Puget Sound Health Care System and the University of Washington, Seattle, is detailed in the current issue of Archives of Internal Medicine.
Testosterone levels can vary wildly between different men and even within individuals as a result of illness or stress. However, studies have consistently shown that levels of the hormone decrease as men age.
Testosterone levels peak during a man’s late 20’s but decline soon after, decreasing about 1.5 percent per year after age 30. The decline is thought to be due to age-related changes in the testes, where the hormone is produced, and in the brain.
Low levels of testosterone can cause decreased muscle mass and bone density, insulin resistance, decreased sex drive, reduced energy, irritability and feelings of depression.
The researchers studied the relationship between testosterone levels and death in a total of 858 male veterans who were age 40 or older. Participants had their testosterone levels checked at least twice between 1994 and 1999. The men were followed for an average of 4.3 years and a maximum of eight years, through 2002.
About 19 percent (166 men) had low testosterone levels; 28 percent (240 men) had varying low and normal levels; and 53 percent (452 men) had normal testosterone levels.
About 20 percent of the men with normal testosterone levels died during the course of the study, compared with 24.6 percent of men with varying levels and 34.9 percent of those with low levels.
Men with low testosterone levels had an 88 percent increase in risk of death compared with those who had normal levels. The effect persisted even after variables such as age, other illnesses and body mass index were controlled for.
The mortality risk for men with low testosterone dropped to 68 percent after the researchers reanalyzed the data to eliminate men who had died within the first year of follow-up. This was done to control for dips in testosterone levels that can occur shortly after surgery, trauma or critical illness.
That the effect still remained high after excluding early deaths suggests the link between low testosterone and mortality is not simply due to acute illness, the researchers say.
However, because the current study is a retrospective study that relies on old medical records, it can only conclude that low testosterone and increased mortality are linked, not how they are linked. For that, a prospective study that follows a group of individuals over a long period of time is needed.
“The men with low testosterone did have higher death rates, but it may be due to some other factor that we weren’t able to measure,” Shores told LiveScience.
Shores also points out that the veterans in her study are a unique subset of the population and that future studies should look at more diverse groups of men.
“They were probably more medically ill than most men their age,” she said. “They all had an average of about 5 chronic illnesses.”
Shores said the results of her study are not conclusive enough for her to recommend testosterone replacement therapy for aging men. Furthermore, the overall risks and benefits of such therapy are not yet known.
“There’s no link between testosterone replacement and prostate cancer but the studies that have been done aren’t big enough to detect if there’s a link or not,” Shores said.
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- Why Men Report More Sex Partners than Women
- The Truth on Longer Life Spans
June 6, 2007 — Low testosterone may lead to a greater risk of death, according to a study presented Tuesday at the annual meeting of the Endocrine Society in Toronto.
Men with low testosterone had a 33 percent greater death risk over their next 18 years of life compared with men who had higher testosterone, according to the study conducted by Dr. Elizabeth Barrett-Connor and colleagues at the University of California at San Diego.
“It’s very exciting and potentially a groundbreaking study,” said Barrett-Connor. “But it needs to be confirmed.”
The study tracked nearly 800 men, 50 to 91 years old, living in California. Their testosterone level was measured at the beginning of the study, and their health was then tracked over the next 20 years.
How Low Is Low?
Testosterone normally declines as men get older. However, a clear definition of “low” testosterone does not yet exist.
“No one knows what low really is,” said Dr. Joel Finkelstein, endocrinologist and associate professor at Harvard Medical School. “The study authors defined it at 250 , which is a definition, but no one has figured out what low is.”
Barrett-Connor and her colleagues found that nearly 30 percent of the men they studied met their criterion score of 250 or lower for low testosterone.
They noted that many men with this definition of low testosterone were “healthy men in the community who would not know that they had low testosterone.”
Men With Hot Flashes
Symptoms of low testosterone depend on how low the level is. At the lowest levels, men will have hot flashes, much like those experienced by women during menopause.
“At levels not quite that low, men have decreases in their libido, erectile dysfunction, fatigue and physiological changes many will not immediately recognize,” Finkelstein said, adding that these could include loss of strength, decrease in bone density and decreased muscle mass.
However, absent symptoms, there is no reason to get testosterone treatment.
“The indication for testosterone is having a low testosterone level in the presence of symptoms, or physiological consequences such as low bone density,” said Finkelstein. “Doctors should not prescribe testosterone because a level is low, or because patients think it will make them live longer.”
Barrett-Connor agrees. “Don’t take testosterone just because you want to feel like you’re 30 again.”
And higher levels of testosterone aren’t necessarily a good thing, either. The study authors found that for those with medium to high levels of testosterone, there was no added benefit for those with boosted levels.
Some of the side effects of testosterone treatment include sleep apnea, thickened blood and a possible increase in prostate disease for certain patients.
For those who actually need testosterone treatment, though, the hormone can be given in a few different ways, including injection and a in gel absorbed through the skin.
“Testosterone injections are given every one to two weeks and can be administered by the patients themselves,” said Dr. Larry Lipshultz, professor of urology at Baylor College of Medicine. “Gels are applied daily.”
Low Testosterone May Hit at the Belt
Men with low testosterone in the study were also more likely to have larger waist girth. These men also appeared to be at higher risk for cardiovascular disease and diabetes.
How testosterone would cause these effects is not yet well understood.
“I don’t know that anybody has worked that out at the molecular level yet,” said Finkelstein.
Researchers say that caution is warranted, as many other factors still remain unknown.
“Men are going to be very excited by this news,” said Barrett-Connor. “But I want people to realize that it’s only an epidemiological study. It’s very good but not definitive.”
Indeed, the study suggested a statistical link — what scientists call an association — between low testosterone and mortality, but it did not prove that one caused the other.
“The next step will be a clinical trial,” said Barrett-Connor. She and her colleagues hope to recruit men with low testosterone to participate in a more rigorous study over the next year.
For now, doctors agree that they still would not prescribe testosterone to patients who are otherwise well.
“It certainly will not change my practice,” said Finkelstein. “I see it more as a challenge to the scientific community to determine if low testosterone really is a cause of increased death and if so, how that occurs.”
Barrett-Connor agrees in proceeding with caution.
What is Low Testosterone?
In recent years, the media has reported more about Testosterone Therpy (TT), and more men between the ages of 40 and 64 have been tested and given TT. Some men with certain symptoms may even want TT without being tested. This action may not be safe or helpful for them. Total testosterone level should always be tested before any TT.
The AUA recommends that TT be prescribed only to men who meet the clinical and laboratory definition of testosterone deficiency (Testosterone level of less than 300 ng/dL). Here are some of the things you will need to know about TT:
- Your doctor will likely measure your testosterone level if you have these conditions:
- Unexplained anemia
- Bone density loss
- Low-trauma bone fracture
- Radiation to your testicles
- HIV/AIDS positive test results
- Chronic narcotic use
- History of infertility
- Pituitary gland disorders
- Even if you do not have specific signs and symptoms, your doctor may test your total testosterone level for these conditions:
- Insulin resistance
- History of chemotherapy
- History of using corticosteroid medicines
- Health changes such as losing weight and getting more physical activity will likely raise your testosterone levels.
- Your doctor will want to check your hemoglobin/hematocrit (Hgb/Hct) levels while you are on TT. This blood test will help check for thickening of the blood.
- Blood thickening may cause blood clots. Your doctor may do Hgb/Hct levels two to six weeks after you start TT and every six to twelve months after that test.
- If you are at risk for heart disease, your doctor will follow you more closely when you are on TT. It also is important to make health changes to decrease the chances for heart and blood vessel disease.
- Your doctor will treat your Low-T level to raise it above 300ng/dl but the exact level may vary.
- Your doctor will watch you for signs and symptoms of improvement. Any changes will likely appear within three to six months of treatment.
- If your total testosterone blood level returns to normal and you still have symptoms, it is likely that there are other reasons for your symptoms. Your doctor may stop TT and try to find out what else might be the problem.
How Do I Take Testosterone?
There are generally five different ways to take testosterone. They are: transdermal (through the skin), injection, oral/buccal (by mouth), intranasal (through the nose), and by pellets under the skin. No method is better than another. While you are taking TT, your doctor will test your blood to determine testosterone levels.
Here are some details about the five different methods:
- Transdermal (Topical). There are topical gels, creams, liquids and patches. Topical medicines most often last for about four days. They absorb better if covered with an air- or water- tight dressing.
- Apply liquids and gels, creams or patches to skin that is dry and without cuts or scratches.
- Do not wash the area until it is time for the next dose.
- Wash your hands after you apply liquids, gels or creams.
- Make sure that other people, especially women and children, do not touch the medicines.
A topical patch is like a band-aid with medicine on it. You put it on and leave it until the next dose is due. The medicine on the patch is less likely than liquids, gels and creams to transfer to others.
- Injection. There are short-acting and long-acting forms of testosterone injection. The short-acting medicine may be given under the skin or in the muscle. The long-acting one is usually given in the muscle. Injections are usually given either weekly, every two weeks, or monthly.
- Oral/buccal (by mouth). The buccal dose comes in a patch that you place above your incisor (canine or “eyetooth”). The medication looks like a tablet but you should not chew or swallow it. The drug is released over 12 hours. This method has fewer harmful side effects on the liver than if the drug is swallowed, but it may cause headaches or cause irritation where you place it.
- Intranasal. This form of testosterone comes in a gel. You pump the dose into each nostril, as directed. It is usually taken three times daily.
- Pellets. Your doctor will place the testosterone pellets under the skin of your upper hip or buttocks. Your doctor will give a shot of local anesthesia to numb your skin, then make a small cut and place the pellets inside the fatty tissues underneath your skin. This medication dissolves slowly and is released over about 3-6 months, depending on the number of pellets.
You may want to choose how you take your testosterone based on what is best or most useful for you. In some cases, your insurance provider may decide the order in which testosterone therapies are provided. Talk about the choices with your doctor.
Are There Side Effects of TT?
There are some side effects of TT. Some side effects are mild while others are more serious. You should ask your doctor or pharmacist about these side effects and watch for them while you are taking TT. Some of the side effects are as follows:
- For gels and liquids, there may be some redness at the skin site. With patches, you may have itching and a rash around the area. A very small number of patients report back pain.
- For short-acting injections, you may have some reaction at the injection site. Some persons have had serious allergic reactions to the long-acting injection. Because of this, when you get the long-acting injection they will watch you closely for a while afterwards in the medical office.
- For testosterone pellets, possible adverse effects include swelling, pain, bruising and, rarely, hematoma (clotted blood under the skin).
- During TT, there is increased risk of erythrocytosis (abnormal raising of blood hemoglobin and hematocrit).
- TT may interrupt normal sperm production. You should not have TT if you plan on having children soon. If you are being treated for Low-T your doctor may suggest added treatment for sperm production.
- Topical testosterone, specifically gels, creams and liquids, may transfer to others. Women and children are most at risk of harmful effects from contact with them. You should take care to cover the area and wash your hands well after putting on the medication. Be careful not to let the site with the topical TT touch others because that could transfer the drug.
- The FDA suggests watching for signs and symptoms of early puberty in a child you live with or have contact with if you use topical testosterone. Do not let children touch the unwashed or unclothed area where you put the drug.
Here are some things you should know:
- There is no evidence linking TT to prostate cancer.
- There is no strong evidence linking TT to increase in vein clots.
- At this time, there is no strong evidence that TT either increases or decreases the risk of cardiovascular events. However, while you are on TT, you should call your doctor right away if you have signs or symptoms of stroke or heart attack.
Low Testosterone: How Low Can It Go?
As if erectile dysfunction weren’t enough to worry about, low testosterone weighs on the minds of many men. Throughout your life, testosterone plays an important role in regulating sexual, mental, and physical health. That’s why low testosterone, or low T as it’s called, can cause common symptoms like erectile dysfunction (ED), low libido, depression, and low energy. The good news in all of this is that very low testosterone is very unlikely, and certain signs will let you know when testing and possible treatment are needed.
How Low Can Testosterone Go?
Unlike women, who have a rapid decline in estrogen at menopause, men may experience a gradual decline in testosterone. Studies show that about 20 percent of men have low T in their sixties and about 50 percent have low T in their eighties. In younger men, low T may be caused by common problems like obesity, diabetes, and stress. Altogether, low T may affect up to 5 million American men.
“The lower your testosterone goes, the more likely you are to have the common symptoms like low energy and low libido,” says Daniel Shoskes, MD, a urologist at the Glickman Urological & Kidney Institute at the Cleveland Clinic in Ohio. “A deep reduction can cause less common symptoms like anemia, osteoporosis, depression, and confusion. But the idea that healthy men’s testosterone levels need to be monitored to prevent these symptoms is probably nonsense.”
When symptoms indicate that you may have a low T problem, a simple test can help make the diagnosis. A morning blood test is the best way to measure testosterone. “There is a very wide range of normal, and testosterone levels change during the day,” says Dr. Shoskes. The normal range is anywhere from 300 to 800 nanograms per deciliter (ng/dL). You would not be considered to have low T unless you had a number below 300.
Dangerously low testosterone levels may occur under certain conditions. One example is treatment for prostate cancer. Because prostate cancer can be fueled by testosterone, doctors may use treatments to block testosterone in advanced cases. This is called androgen deprivation therapy (ADT).
One example of ADT is surgical removal of the testicles. This will drop testosterone levels by more than 90 percent in 24 hours. Another way to block testosterone is with drugs. In a study published in the journal Clinical Genitourinary Cancer, researchers looked at the testosterone levels of men being treated for prostate cancer with an ADT drug after six months. Of 153 men, 25 were found to have a testosterone level less than 20 ng/dL.
At these lowest levels of testosterone, low T symptoms may include:
- Complete loss of libido
- Severe ED
- Tender and enlarged breasts
- Hot flashes
- Weight gain
- Severe fatigue
- High cholesterol
When to Talk With Your Doctor About Low T
If you’re an otherwise healthy adult man, you’re not likely to experience dangerously low testosterone. But you should talk with your doctor if you have ongoing symptoms of low T.
A review article in the BC Medical Journal suggests that your doctor might consider a blood test to diagnose low T if you have persistent symptoms that include:
- Mood changes such as irritability or sadness
- Loss of interest in sex
- Loss of morning erections or other erection problems
- Low energy and easy fatigue
- Loss of muscle strength or bulk
Very low testosterone is very unlikely and you probably do not need to worry about it. But if you have persistent symptoms of falling testosterone levels, talk with your doctor about low T. Diagnosing low T early may help prevent more serious low T symptoms later on.
The Men’s Clinic at UCLA – Low Testosterone / Hypogonadism
In the U.S. today, it’s estimated that more than fifteen million adult men have low testosterone, also known as hypogonadism or low lobido. Symptoms of this condition include loss of libido, diminished frequency and quality of erections, decreased enjoyment of life, decreased ability to concentrate and decreased sports performance. Testosterone deficiency is highly associated with multiple disease states including obesity, diabetes, hypertension, high cholesterol and asthma. Hypogonadism is also seen in men taking chronic narcotics, men with chronic pain and men with a history of head trauma.
Low Testosterone / Hypogonadism: Diagnosis
Low testosterone is diagnosed through a blood test where physicians look for the level of testosterone, free testosterone, sex hormone binding globulin (SHBG,) and pituitary hormones important in male hormone production.
Low Testosterone / Hypogonadism: Treatment
Testosterone replacement therapy (TRT) can be administered in many forms. Most patients will begin their treatment process with transdermal (TD) application routes. The most common form is a gel that is applied to clean, dry skin every day at the same time, usually after a man gets out of the shower. TD application is easy, well-tolerated and allows for excellent absorption of testosterone and an even delivery of the hormone throughout the day. There are minimal side effects. Some men will have a mild skin irritation while others may see an increase in their hematocrit, which will then need to be monitored. Men on TD therapy do need to be careful not to have skin to skin contact with other individuals until the application site is washed. Most products absorb after 2 hours of skin contact so washing the area after 2 hours provides the safest way to avoid transmission of active testosterone to others.
Once starting TRT, patients should notice improved energy levels, exercise tolerance, libido and erectile function within the first few weeks of therapy. Long term results may include weight loss, especially when combined with a vigorous exercise and nutrition regimen. Optimal results will be achieved within about three to six months. Periodic symptom and blood monitoring is essential to good therapeutic response. Once your UCLA Men’s Clinic physician has you on a stable dosing regimen, he or she will check bloodwork every 6 months or so to ensure safety.
Injection therapy is another effective option. There is a lot of flexibility with injection therapy as your physician can alter the dose and schedule of injections to maximize your testosterone levels. It is a very effective therapy, but it does require the patient or patient’s partner to learn how to inject or make frequent office visits.
Scheduling an Appointment
Board-certified urologists staff The Men’s Clinic at UCLA and you can be assured you are getting an experienced physician performing your evaluation and treatment in a relaxed and comfortable environment. For more information and to schedule an appointment, please call the UCLA Urology Appointment line at (310) 794-7700.
Treating low testosterone levels
Men naturally lose testosterone as they age, but there are “low-t” treatments available.
Updated: August 9, 2019Published: December, 2016
Testosterone is the hormone that gives men their manliness. Produced by the testicles, it is responsible for male characteristics like a deep voice, muscular build, and facial hair. Testosterone also fosters the production of red blood cells, boosts mood, keeps bones strong, and aids thinking ability. Lack of testosterone, often nicknamed, low-t, can cause unwanted symptoms.
Testosterone levels peak by early adulthood and drop as you age—about 1% to 2% a year beginning in the 40s. As men reach their 50s and beyond, this may lead to signs and symptoms, such as impotence or changes in sexual desire, depression or anxiety, reduced muscle mass, less energy, weight gain, anemia, and hot flashes. While falling testosterone levels are a normal part of aging, certain conditions can hasten the decline. Low t risk factors include:
- injury or infection
- chemotherapy or radiation treatment for cancer
- medications, especially hormones used to treat prostate cancer and corticosteroid drugs
- chronic illness
Millions of men use testosterone replacement therapy to restore low levels and feel more alert, energetic, mentally sharp, and sexually functional. But it’s not that simple. A man’s general health also affects his testosterone levels. For instance, being overweight, having diabetes or thyroid problems, and taking certain medications, such as glucocorticoids and other steroids, can affect levels. Therefore, simply having low-t levels does not always call for taking extra testosterone.
Diagnosing low testosterone
Doctors diagnose low testosterone based on a physical exam, a review of symptoms, and the results of multiple blood tests since levels can fluctuate daily.
If your doctor diagnoses low testosterone, other tests may be considered before therapy. For example, low-t can speed bone loss, so your doctor may recommend a bone density test to see whether you also need treatment for osteoporosis.
Prostate cancer is another concern, as testosterone can fuel its growth. As a result, the Endocrine Society recommends against testosterone supplementation for men in certain situations, including those who:
- have prostate or breast cancer
- have an elevated blood level of prostate-specific antigen (a blood test used to screen for prostate cancer)
- have a prostate nodule that can be felt during a rectal exam.
Other circumstances in which testosterone supplementation is not recommended include:
- a plan to become a father in the near-term
- an elevated red blood cell count
- severe, untreated sleep apnea
- severe lower urinary tract symptoms
- poorly controlled heart failure
- heart attack or stroke within the last 6 months
- a tendency to form blood clots (a condition called thrombophilia)
Testosterone therapy for low levels
In most cases, men need to have both low levels of testosterone in their blood and several symptoms of low testosterone to go on therapy.
It is possible to have low levels and not experience symptoms. But if you do not have any key symptoms, especially fatigue and sexual dysfunction, which are the most common, it is not recommended you go on the therapy given the uncertainty about long-term safety.
Even if your levels are low and you have symptoms, low-t therapy is not always the first course of action. If your doctor can identify the source for declining levels—for instance, weight gain or a particular medication—he or she may first address that problem.
If you and your doctor think testosterone replacement therapy is right for you, there are a variety of delivery methods to consider, as found in the Harvard Special Health Report Men’s Health: Fifty and Forward.
- Skin patch. A patch is applied once every 24 hours, in the evening, and releases small amounts of the hormone into the skin.
- Gels. Topical gels are spread daily onto the skin over both upper arms, shoulders, or thighs. It is important to wash your hands after applying and to cover the treated area with clothing to prevent exposing others to testosterone.
- Oral therapy. Capsules are swallowed or tablets are attached to your gum or inner cheek twice a day. Testosterone is then absorbed into the bloodstream.
- Pellets. These are implanted under the skin, usually around the hips or buttocks, and slowly release testosterone. They are replaced every three to six months.
- Injections. Various formulations are injected every seven to 14 days. Testosterone levels can rise to high levels for a few days after the injection and then slowly come down, which can cause a roller-coaster effect, where mood and energy levels spike before trailing off.
Most men feel improvement in symptoms within four to six weeks of taking testosterone replacement therapy, although changes like increases in muscle mass may take from three to six months.
– By Matthew Solan
Executive Editor, Harvard Men’s Health Watch
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