Our urology team offers safe and effective treatments to help men with low testosterone levels. Our urologists can prescribe Testosterone Replacement Therapy (TRT) through pills, shots, creams, or patches to increase the levels of testosterone in your body.
Low testosterone, otherwise known as hypogonadism, is a condition which affects many men as they age. Testosterone is produced in the adrenal glands and testes of males. The release of testosterone is regulated by the brain (hypothalamus and pituitary glands). Testosterone is a sex hormone essential for boys during puberty for development. Testosterone allows for the development of male physical features and sexual function. As boys exit puberty and enter adulthood, testosterone maintains muscle strength and mass, hair growth, bone density, sexual functions, energy and mood levels. Testosterone is also needed for sperm production. Generally, testosterone levels are highest in the morning and lowest in the evening but fluctuation does occur with age.
About Low Testosterone:
As men age, it is normal for their testosterone levels to decrease. About 4 out of 10 men over the age of 45 will have decreased testosterone levels. This affects sex drive, body fat, energy levels, and more. Many studies have demonstrated a decline in serum testosterone concentration with increasing age. The amount of testosterone that classifies as “low testosterone” is generally below 300 ng/dl. Yet there is debate among different medical societies and many suggest 270-1070 ng/dl as a normal testosterone range.
Sometimes referred to as “andropause,” low testosterone levels are often compared to menopause in women. However, in menopause there is a complete estrogen deficiency causing known clinical side effects. Men have decreased levels of their sex hormone with less obvious clinical consequences.
Causes of Low Testosterone:
It is expected that most men will have some decline in testosterone as they age. Usually these declines are insignificant and do not cause noticeable symptoms. There are various factors that could cause low testosterone levels. Some of these include:
- Organ Damage or Failure: If there is injury/damage to an organ responsible for producing or releasing testosterone, low testosterone can occur. Infections, prior surgeries, radiation, chemotherapy, or certain medications may compromise organs involved in testosterone production and regulation.
- Lifestyle: Certain lifestyle choices can impact testosterone levels. Obesity is a major contributor to low testosterone. This is because fat cells convert testosterone to estrogen. Hypertension (high blood pressure), kidney disease, high cholesterol, diabetes, HIV/AIDS, COPD may also cause low testosterone.
- Smoking and Drugs: Smoking, alcohol, and drug abuse (especially opioids) have been shown to decrease testosterone levels. It is estimated that 75/100 men who have been taking opioids long-term have low testosterone.
- Psychological Conditions: Certain psychiatric conditions may cause low testosterone. Depression and anxiety are among the most common that can cause low testosterone.
- Other: Other conditions may cause low testosterone. Concurrent illness, inflammatory conditions, certain genetic anomalies, and endocrine issues may affect testosterone levels.
Low Testosterone Symptoms:
As describe above, men may or may not notice symptoms of low testosterone. Additionally, some of the symptoms of low testosterone overlap with other conditions. However, some of the more common symptoms adult men with low testosterone include:
- Sleep disturbances
- Decline in memory/cognitive function
- Decrease in body hair
- Erectile dysfunction (ED)
- Enlarged breasts (gynecomastia)
- Reduced or absent orgasm
- Reduced or low sex drive
- Fatigue or lack of energy
- Increase in body fat, loss of muscle
Risk Factors for Low Testosterone:
- Chronic opioid use
- Alcohol abuse
- Pituitary disorders
How We Diagnose Low Testosterone:
Due to the magnitude of different causes of low testosterone our urologists utilize a team approach to determine potential causes. Besides obtaining a detailed history, work up for low testosterone generally includes:
- Physical exam
- Blood tests
Possible Side Effects from Low Testosterone Treatments:
With any medications or medical therapies, there are potential risks and adverse side effects. These may be, but are not limited to:
- Skin irritation
- Breast enlargement or soreness
- Elevated red blood cell count
- Swelling of the lower extremities
- Elevated red blood cell count
- Changes in prostate symptoms
Patients are typically monitored every 3-6 months for symptom improvement and adverse events with examination, total testosterone, PSA, and hematocrit levels.
- Gels, creams, and patches
- Patches may be applied each night to your skin.
- Gels and creams can be applied to certain parts of your body. They absorb through your skin and cause fewer skin reactions compared to patches.
- A potential risk for gels and creams is transferring the testosterone to others you come into physical contact with. Gel is the most common type of treatment.
- Subcutaneous pellets
- Pellets containing testosterone (Testopel) can be implanted under the skin. This is a minor procedure done in our office. These pellets need to be implanted every 3-6 months.
Approximately 10% of men over age 40 have low testosterone levels