Low T

Often there is no obvious reason for men to have Low T, but there is a known association in obesity, diabetes, depression, pain killers (narcotics), HIV, unexplained anemia, male infertility, use of steroids, prior stroke or heart attack, chemotherapy, prior testicular radiation, pituitary diseases, and hemochromatosis.

Low T should NOT be treated unless men have low levels of testosterone AND symptoms:

• reduced energy/endurance
• lower physical performance
• poor memory/concentration
• reduced sex drive/motivation
• depression

If Low T seems likely based upon the symptoms, an early morning blood testosterone level is checked. If it is low, it’s checked a second time to be certain. Additional hormonal tests to check the function of the pituitary and hypothalamus may also be performed. If these latter tests are abnormal, your urologist may order imaging of the brain, and may need to have an endocrinologist involved in the evaluation.

Men with Low T may have undiagnosed high blood pressure, abnormal lipid profile, early diabetes, or anemia – all of which contribute to the risk of stroke or heart attack. Your urologist may advise screening for and treating these risk factors. Likewise, some men with Low T have low bone mineral density (risk for bone fracture with low trauma), so a bone densitometry test may be needed.

Replacing testosterone may improve sex drive and erectile dysfunction. It may help to correct anemia, bone loss and depression. The data is unclear whether supplemental testosterone will improve energy levels, abnormal lipids and quality of life measures.

All men with Low T should try to maintain an ideal body weight and exercise and eat a healthy diet. This not only reduces cardiovascular risks, but may improve natural testosterone level.

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. Some men do not absorb these products and may need a different brand or different delivery system (see below).

Testosterone patch – applied once daily, occasionally causes skin irritation.

Testosterone intramuscular shots – both short acting (given every 1-3 weeks) and long acting (every 10 weeks)

Testosterone subdermal pellets – 10 minute procedure to place about 10-12 small pellets under the skin of your gluteal area. The pellets slowly absorb over a 4-6 month period. The procedure may occasionally cause local swelling or pain.

Buccal testosterone – small patch of testosterone placed twice daily up in the gums to the right or left of the front teeth

Nasal testosterone – 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.

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

American Urological Association: https://www.auanet.org/
UCF, Corporate websites

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 (see glossary), 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 – testosterone shots or testosterone gels/creams?
Both can achieve normal levels of testosterone in most men. Short acting shots are less convenient (many trips to the office), but they are inexpensive. 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). Short acting intramuscular shots may have a slightly higher risk of developing a high blood count (erythrocytosis – see Glossary). Gels and creams are much more “natural.” They are taken daily and simulate the natural daily cycle of testosterone without the “highs and lows” that may be seen with shots. Not everyone can absorb the gels and get a therapeutic level of testosterone.

Will testosterone supplements make me have better erections?
Studies are inconsistent about this. Many men report that they have an easier time getting erections, more nighttime erections, and harder erections; however, not everyone sees 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 supplements 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 Low T 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.