“Low T” or low testosterone is a drop in a man’s hormone levels that may leave him with significant symptoms. The symptoms of low testosterone, also known as hypogonadism, are often overlooked because they are mistaken for ordinary signs of aging. Men with below-normal testosterone may experience the following symptoms:
- Decreased interest in sex
- Significant tiredness (fatigue)
- Erectile dysfunction
- Muscle weakness
- Small or soft testicles
- Weight gain
- Reduced bone density
What is Testosterone?
Testosterone is a natural hormone in the human body that is responsible for the development of muscle mass, bone density, sperm production in men, regulation of sex drive (libido), fat distribution and metabolism (burning fat), and the production of red blood cells in the bone marrow. For men, it is an important hormone and a fundamental building block of a healthy body. Testosterone also plays major roles in cognitive functions, concentration, energy levels, and regulating healthy sleeping habits.
Benefits of Healthy Testosterone
Our goal is for men to live a fulfilling life, with nothing holding you back. If your testosterone is low you may notice a decrease your stamina, exercise tolerance, sex drive and mood. It also has important implications for your heart and bone health. If you are a candidate for Testosterone therapy, we will work with you to develop a treatment plan to optimize your health and let you live the life you want to live.
When testosterone levels are normalized with treatment men will often see: increased energy, improved libido, better exercise tolerance, improved muscle mass, strength and stamina, decreased irritability depression, happier and increased positive outlook on life, improved cognitive functions, ability to focus, and mental drive, drastically improved relationships with their loved ones.
How Does Low-T Happen?
Testosterone levels can drop somewhat as you age, but significant and/or premature decrease can be the result of common medical problems (obesity, diabetes, sleep apnea, and others) or other rare medical conditions. The lack of testosterone can have harmful effects on your cardiovascular system, bone health, mental health, etc. The evaluation you will receive at Men’s Health Virginia will screen for all of these factors and may pick up important, even life-threatening health issues (cancers, etc.) that you didn’t know you had.
How is Low-T Evaluated?
To evaluate you for Low-T, we send an early morning blood testosterone level, preferably prior to 10 AM. If it is low, we check it a second time to be certain the testosterone is truly low. We may also order additional hormonal tests to check the function of the pituitary and hypothalamus. If these latter tests are abnormal, we may advise imaging of the brain, and we may need to have an endocrinologist involved in the evaluation. We will also frequently obtain baseline testing for prostate cancer (PSA) and blood counts (hemoglobin/hematocrit).
Men with hypogonadism may have undiagnosed high blood pressure, abnormal lipid profile, early diabetes, anemia – all of which contribute to the risk of stroke or heart attack. Men with erectile dysfunction may have cardiovascular disease which may also increase the risk for stroke or heart attack. We advise screening for and treating these risk factors. Also, some men with hypogonadism may have low bone mineral density (risk for bone fracture with low trauma), so a bone densitometry test may be needed.
How Can You Replace Testosterone?
There are a number of options and you can pick what works best for you, most importantly, they are usually covered by insurance! Most commonly men choose topical gels, shots, or implanted pellets. We follow established, medically-supported, evidence-based guidelines and protocols, and perform routine lab testing to ensure your safety.
Listed below are the Testosterone products currently available:
Testosterone gels and creams
– These are the most common products used to replace testosterone. Depending on the product, they may be applied to the shoulders, upper arms, armpits, or thighs. The advantage of gels is ease of use. Disadvantages include transference to others who may come in contact the gel. Also, some men do not absorb these products well and may need a different brand or different delivery system (see below).
– the testosterone patch is applied once daily, and may cause skin irritation.
Testosterone intramuscular shots
– both short acting (given every 1-3 weeks) and long acting (every 10 weeks) injection are available. Advantages of injections are decreased frequency of dosing and there is no risk of transference. Disadvantages include pain with injections and a “rollercoaster effect” as testosterone levels rise and fall.
Testosterone sub-dermal pellets
– placement of pellets involves a 10-minute procedure to place about 8-12 small pellets under the skin of your gluteal area (upper buttock). The pellets slowly absorb over a 3-6 month period. The procedure may cause local swelling or pain and risks include a low risk of bleeding, infection and expulsion of the pellets.
– small patch of testosterone placed twice daily up in the gums to the right or left of the front teeth
– Nasal gel dispensed by a pump into the nose about 3 times daily.
The choice of treatment is yours. Your personal preference and the cost of these medications may drive the decision.
Monitoring after Starting Therapy
After starting testosterone replacement therapy, you will have intermittent scheduled appointments to make sure your symptoms are under good control, your testosterone levels remain normal, and you are not having any side effects from your treatment. Your testosterone levels will be followed as well as intermittent testing of your blood counts (hemoglobin/hematocrit), liver function tests, and PSA.
Testosterone and Fertility
Men who are wanting children in the future should not take testosterone replacement. There are other options for naturally boosting Testosterone that maintain healthy sperm production, and our experts are happy to discuss that with you.
Frequently Asked Questions
If I have Low T, should I be taking testosterone?
The current recommendation is to treat if you have Low T AND the symptoms of hypogonadism, exceptions might be if you are trying to treat anemia or poor bone density.
Isn’t there a testosterone pill that I can take?
No! Oral testosterone can lead to liver damage and is simply not available in the US.
Which are better: 1. testosterone shots or 2. testosterone gels/creams?
Both can achieve normal levels of testosterone in most men. Short acting shots are inexpensive and avoid possible transference to other individuals. Shots may cause higher than normal levels in the first few days, then lower than normal levels towards the end (right before the next shot is due). Some patients may notice a “roller coaster effect” of their symptoms due to this variation in their testosterone levels. Short acting intramuscular shots may have a slightly higher risk of developing a high blood count (erythrocytosis – see Glossary). Gels and creams are used daily and simulate the natural daily cycle of testosterone without the “highs and lows” that may be seen with shots. Not everyone will absorb the gels and get a therapeutic level of testosterone.
Will testosterone supplements make me have better erections?
Studies are inconsistent. Many men report that they have an easier time getting erections, more nighttime erections, and harder erections. But not everyone has this improvement.
What are the risks of taking testosterone therapy?
Taking too much testosterone can cause a rise in your red blood cell count , a risk for stroke or heart attacks. Your doctor will measure your blood count before and after starting therapy.
A few men taking testosterone develop breast tenderness or enlargement.
The prostate may enlarge and cause urinary symptoms.
There is no evidence that testosterone supplement cause prostate cancer. To be safe, your doctor will monitor your prostate exam and PSA blood test before and after treatment.
It’s not advised to take testosterone if you have active prostate or breast cancer.
The FDA has issued warnings about the cardiovascular risks associated with testosterone replacement. On the other hand, the guidelines of the American Urological Association state there is no strong evidence that testosterone replacement for hypogonadism will cause clots in legs or change your cardiovascular risk.
Stay tuned for more data on this subject.
Risks are higher if you take testosterone without knowing your starting level. To be safe, if you are taking testosterone and experience chest pain, shortness of breath, slurred speech, or weakness on one side of your body, you should call your doctor.
Can the testosterone gels and creams transfer to my wife or kids?
YES! Wash your hands after applying these products. Wait until the gel or cream is fully absorbed through the skin before you contact your wife or children.
If I have Low T and want to have kids, should I take testosterone?
Men who have low T and desire children should NOT receive testosterone products. It can shut down the production of sperm. These men need different medications that stimulate the body to make more of its own natural testosterone. A urologist or endocrinologist can review your options.
Glossary of Terms:
Erythrocytosis – also called Polycythemia – a rise in your red blood cell count that can be occasionally caused by testosterone therapy. It can be treated by stopping the testosterone or periodic phlebotomy (blood letting).
Hypogonadism (low T) – blood levels of testosterone are low and there are symptoms that could include low energy/endurance, low sex drive/motivation, erectile dysfunction, poor memory/concentration, depression, loss of muscle mass.
Low Testosterone (low T) – see “Hypogonadism”