Hypogonadism / Low Testosterone
What is testosterone?
- It is the most abundant sex hormone in a man’s body. In adulthood, testosterone helps maintain sexual function, sex drive, sperm production, and muscle & bone health.
What causes low testosterone?
- Low testosterone can result from problems with the testes (where testosterone is made) or problems with the brain or pituitary gland.
- Testicular problems include damage from injury, infection or medications, certain inherited genetic abnormalities, and dilated veins in the scrotum (called varicoceles)
- Brain/pituitary problems- often of unknown cause and are very common with aging. Benign pituitary tumors can also cause problems.
What are symptoms & signs of low testosterone?
- Low sex drive
- Erection problems
- Depressed mood
- Reduced muscle mass and strength
- Increased body fat
- Decreased bone mineral density
How do we evaluate low testosterone?
- You will have two simple blood tests done to determine if your level is low (T,SHBG)
- If you are found to have low testosterone, we will check a few other blood tests to determine why your testosterone level is low- to determine if it is a problem with the testes or a problem with the brain or pituitary gland
- If you have a low testosterone, we will prescribe testosterone therapy to normalize the level
How is low testosterone treated?
- Testosterone therapy:
- Testosterone injection: Injections are given every 2 weeks into the muscle. Testosterone levels peak about 3 days
- after the injection and then slowly decline over the next weeks. Sometimes symptoms gradually return as the level is dropping, which some men find bothersome. Others are not bothered.
- Testosterone gel: Gels are placed on the skin daily, providing a consistent level of testosterone throughout the day. There are a variety of brand-name gels on the market- application instructions vary for the differing products. Risks of gels include skin irritation at application site and transferring the medication to other people with prolonged skin contact (particularly a risk with skin-to-skin contact with infants and pregnant women).
- Testosterone pellets (Testopel): T pellets are a convenient, long-acting form of testosterone therapy. The pellets are about the size of a grain of rice and are inserted under the skin on the buttock. Insertion is done in a quick, virtually painless, 10-minute procedure in our office. The pellets release a constant supply of testosterone and are effective for 3-6 months. Advantages include not having to come to the office twice monthly for a shot, no risk of transferring T to others, and no need for daily application of a gel.
What are the risks of testosterone therapy?
- Prostate cancer: Prostate cancer is very common in men as they age. It is currently thought that testosterone therapy DOES NOT cause prostate cancer, but may stimulate any prostate cancer which is already present to grow and potentially cause problems. After starting testosterone therapy, you will need to have a blood test (PSA) done to monitor the health of your prostate.
- Increased red blood cells: A condition called “polycythemia” can arise as testosterone stimulates the body to produce red blood cells. If the level of the red blood cells is too high, testosterone may need to be adjusted. You will have a blood test (Hematocrit) done to monitor RBC production.
- Breast tenderness: Swelling & tenderness of the breasts can potentially occur, and usually improves after a few weeks.
- Sleep apnea: Sleep apnea can be worsened by testosterone therapy. It is safe for men with sleep apnea to trial testosterone therapy, but we will need to monitor your response to therapy.
- Edema: Swelling in the legs is occasionally seen and is generally not a significant problem. If swelling is associated with difficulty breathing, notify our office immediately.
How will I be monitored while taking testosterone?
- When taking testosterone, you will need to come to clinic periodically to discuss symptoms and potential side effects, and to have a physical exam. Periodically, blood testing will need to be done to measure your testosterone levels. Additional blood testing is performed to monitor your blood counts, and to monitor your PSA level if you are older than 45 years of age and have elected to have prostate cancer screening performed. Bone density is sometimes recommended to evaluate for osteoporosis.
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