What is Low Testosterone?
Low testosterone is also known as “low T,” hypogonadism, and hypoandrogenism. Beginning around the age of 30, testosterone levels in men often start to decline. This can result in a variety of symptoms ranging from fatigue, difficulty with exercising and gaining muscle, weight gain, decreased sex drive, and erectile problems. Testosterone, in spite of its popular image as the sex hormone, is more complicated than we think. It is essential for normal functioning and development of the male body.
Symptoms of Low Testosterone
If you experience any of the following symptoms, it is possible that you have hypogonadism, also known as low testosterone or “low T.”
- Low energy or fatigue
- Low sex drive or libido
- Difficulty with erections (erectile dysfunction)
- Weight gain or increase in body fat
- Difficulty exercising
- Decrease in muscle mass
- Memory changes
- Difficulty concentrating
- Symptoms of depression
- Decrease in motivation, initiative, and self-confidence
- Loss of armpit or pubic hair
- Decrease in height
- Low sperm count
Testosterone and Infertility
Oftentimes, infertility and low testosterone go hand in hand. In the appropriate patient, raising testosterone levels with medication (e.g. clomiphene citrate, anastrozole, hCG) can help improve sperm parameters. Be wary that testosterone replacement will actually cause sperm counts to decline, something that many patients are not appropriately counseled on when they are prescribed testosterone by another provider.
Testosterone and Prostate Cancer
Testosterone can cause prostate cancer to grow. This has led to a concern that testosterone therapy could cause prostate cancer or cause recurrence of prostate cancer in men who have previously been treated. However, studies have now demonstrated that raising testosterone to normal levels does not cause prostate cancer nor does it cause recurrence of previously treated prostate cancer. We would not want to prescribe testosterone medication if you have active prostate cancer that has not yet been treated. Men who are 40 or older and are on testosterone replacement therapy should be regularly screened for prostate cancer with prostate exams and PSA blood tests.
Treatment Options for Low Testosterone
Testosterone therapy can be a safe and effective way to treat symptoms of low testosterone. Individualized, long-term testosterone therapy has been shown to improve bone density, stabilize mood, normalize body fat and body muscle, increase energy, and increase libido. Low testosterone can be treated with testosterone replacement therapy or with medication that helps your body make more testosterone on its own. These are some of the treatment options that we prescribe:
Testosterone cypionate or testosterone enanthate are preparations of testosterone which can be delivered by injection into your thigh or buttocks, or subcutaneously in some cases. We usually teach you or your partner to administer the injections every one to two weeks. Aveed (testosterone undecanoate) is an intramuscular injection that must be administered in clinic, but it lasts 10 weeks.
Testosterone can be delivered in the form of patches, gels, or creams. Gels and creams are usually administered daily or twice a day and can be applied to different locations depending on the type, such as the back, shoulders, thighs, or even intranasally. Patches are applied once a day and can be placed on the back, abdomen, upper arms, or thighs. There are generic formulations and brands, such as Testim, AndroGel, Axiron, Fortesta, Natesto (nasal), and Androderm (patch).
Testopel pellets are small testosterone implants that are inserted under the skin of the buttock or “love handles” in a simple five-minute procedure in the clinic. These pellets are slow-release and last for about three to four months, and the number of pellets inserted can be adjusted according to your needs.
Instead of directly providing testosterone replacement, these drugs help your body to produce more of its own testosterone from the testicles. Testosterone replacement usually slows down or completely stops sperm production. Thus, these medications are often given to patients who would like to preserve (or even improve) their sperm counts. Sometimes they are given to patients who were previously on testosterone replacement but would now like to have children.