Testosterone is the male sex hormone that is made in the testicles. Testosterone hormone levels are important to normal male sexual development and functions.During puberty (in the teen years), testosterone helps boys develop male features like body and facial hair, deeper voice, and muscle strength. Men need testosterone to make sperm.

 

Testosterone levels generally decrease with age, so older men tend to have low blood testosterone levels.Some men have low testosterone levels. This is called Testosterone Deficiency Syndrome (TD) or Low Testosterone (Low-T). The American Urology Association (AUA) identifies low blood testosterone (Low-T) as less than 300 nanograms per deciliter (ng/dL).

 

Symptoms of low testosterone include:

• Low sex drive

• Fatigue

• Reduced lean muscle mass

• Irritability

• Erectile dysfunction

• Depression

• Poor memory / concentration

How Common is Low Testosterone in Men?

It is hard to know how many men among us have TD, although data suggest that overall about 2.1% (about 2 men in every 100) may have TD. As few as 1% of younger men may have TD, while as many as 50% of men over 80 years old may have TD.

 

TD is more common in men who have diabetes or who are overweight. In one research study, 30% of overweight men had Low-T, compared to only 6.4% of those with normal weight. The same study found diabetes to be a risk factor for TD. In another study, 24.5% of men with diabetes had Low-T, compared to 12.6% of those without diabetes.

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What are some causes of low testosterone?

Damage to testicles by accident

Removal of testicles because of cancer

Chemotherapy or radiation

Pituitary gland disease leading to hormone deficiency

Infection

Autoimmune disease (when the body makes antibodies that attack its own cells)

Aging

Obesity

Metabolic syndrome (high blood pressure, high blood sugar, unhealthy cholesterol levels, and belly fat)

Medications such as antidepressants and narcotic pain medications

HIV/AIDS

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How do you test for low testosterone?

Some blood tests that may be ordered during your visit include:

Total testosterone level (two different times on samples taken before noon as T levels decrease later in the day)

Luteinizing hormone (LH)

Follicle stimulating hormone (FSH)

Prolactin

Estradiol

Hemoglobin

HbA1C (diabetes)

You may also need to have semen tests. 

How Do I Take Testosterone?

There are generally five different ways to take testosterone.

• Transdermal (through the skin)

  • Topical gels, creams, liquids and patches

• Injection

  • Short acting & long acting; given every 1-4 weeks​

  • Some options:

    • Xyosted

    • Testosterone cypionate

• Oral/buccal (by mouth)

• Intranasal (through the nose)

  • Gel pumped into each nostril taken 3-4 times per day (natesto)​

• Pellets under the skin

  • Placed under the skin of your upper hip or buttocks

  • Performed in the office with local anesthesia

  • Dissolves slowly and is released over about 3-6 months, depending on the number of pellets

 

You may want to choose how you take your testosterone based on what is best or most useful for you. In some cases, your insurance provider may decide the order in which testosterone therapies are provided. 

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Other medications that can potentially increase testosterone include:

• clomiphene citrate

  • selective estrogen receptor modulator​

  • works via negative feedback (increased LH, FSH) to stimulate testicles to produce more testosterone and sperm

  • can be used alone or in conjunction with testosterone replacement therapy

• HCG

  • act like LH and stimulates Leydig cells in testicle to produce more testosterone​

  • can be used alone or in conjunction with testosterone replacement therapy

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Are There Side Effects of TT?

For gels and liquids, there may be some redness at the skin site. 

Topical testosterone, specifically gels, creams and liquids, may transfer to others.

With patches, you may have itching and a rash around the area. A very small number of patients report back pain.

For short-acting injections, you may have some reaction at the injection site. Some persons have had serious allergic reactions to the long-acting injection.

For testosterone pellets, possible adverse effects include swelling, pain, bruising and, rarely, hematoma (clotted blood under the skin).

 

During TT, there is increased risk of erythrocytosis (abnormal raising of blood hemoglobin and hematocrit).

TT may interrupt normal sperm production. You should not have TT if you plan on having children soon. If you are being treated for Low-T your doctor may suggest added treatment for sperm production.

 

There is no evidence linking TT to prostate cancer.

There is no strong evidence linking TT to increase in vein clots.

At this time, there is no strong evidence that TT either increases or decreases the risk of cardiovascular events. However, while you are on TT, you should call your doctor right away if you have signs or symptoms of stroke or heart attack.

 

After Treatment

Remember that each person is unique, and each body responds differently to treatment. TT may help erectile function, low sex drive, bone marrow density, anemia, lean body mass, and/or symptoms of depression. However, there is no strong evidence that TT will help memory recall, measures of diabetes, energy, tiredness, lipid profiles, or quality of life.

 

You will need routine checkups to see that your testosterone level stays normal. In patients who are stable on TT, total testosterone and certain other lab tests should be checked every 6-12 months.