Low T Quiz

Testosterone Therapy in Men: Potential Benefits and Risks

Are you considering testosterone therapy to help you feel younger and more vigorous as you age?

Get to know the risks and benefits before you make your decision.
Having testosterone therapy may sound like a great idea. The desire to feel 20 years younger may make testosterone sound attractive according to popular advertising. But is this the right treatment for you? There are a lot of misconceptions about what the treatment can and can’t do for you. As you get older, testosterone therapy may sound like the ultimate anti-aging formula.

What is Testosterone? Testosterone is the male sex hormone that is produced in the testicles. Hormones are important for physical and mental health. Testosterone is the most important hormone in men. While it helps to maintain sex drive, sperm production, pubic hair and body hair, testosterone is also responsible for maintaining muscles and bones.

When testosterone production is low in men, sexual dysfunction is a common complaint; but other nonspecific symptoms such as depression, mood changes, weight gain, or fatigue, have been reported.
Testosterone is a steroid hormone that is made in the testes in males and in the ovaries in women (a minimal amount is also made in the adrenal glands).

Testosterone production is regulated by hormones released from the brain. The hypothalamus and pituitary gland, located in the brain, produce hormonal signals that ultimately result in the production of testosterone. These hormones travel through the bloodstream to activate the sex organs in both men and women.

Testosterone is essential for:

  • Normal male sexual development and functions
  •  Develop male characteristics such as facial/body hair and deeper voice
  •  Muscle strength and mass
  •  Production of sperm
  •  Male sex drive
  •  Red blood cell production
  •  Bone density
  •  Fat distribution

What are the possible symptoms of low testosterone?

  • Lower sex drive
  • Fewer spontaneous erections
  • Loss of body hair
  • Less beard growth
  • Loss of lean muscle mass & strength
  • Feeling very tired all the time (fatigue)
  • Increased body fat / Obesity (being overweight)
  • Lower energy, endurance, and physical strength
  • Swollen or tender breast tissue (gynecomastia)
  • Poor memory
  • Insomnia or trouble sleeping
  • The trouble with finding words to say
  • Poor focus
  • Feeling sad or depressed
  • Not doing well at work
  • Decreased bone density
  • The decrease in motivation and self-confidence
  • Erectile dysfunction

What Causes Low Testosterone?

There are many reasons for low testosterone. Basically your testicles for whatever reason are producing less testosterone. In addition, testosterone gradually declines with age — typically about 1 percent a year after age 30 or 40. It is important to determine in older men if a low testosterone level is simply due to the decline of normal aging or if it is due to a disease (hypogonadism). Hypogonadism is a disease in which the body is unable to produce normal amounts of testosterone due to a problem with the testicles or with the pituitary gland that controls the testicles.

Low testosterone is a blood level lower than 300 ng/ dl in combination with any of the symptoms listed below.

  • Aging
  • Obesity (overweight)
  • Harm to testicles by accident
  • Removal of testicles (because of cancer or other reasons)
  • Chemotherapy or radiation
  • Medication side effects such as
  • Opioid or antidepressant use
  • Thyroid problems
  • Depression
  • Medical conditions you may be born with
  • Diabetes
  • Infection
  • Pituitary gland disease leading to low hormone production
  • Autoimmune disease
  • Alcohol

How is low testosterone diagnosed?

The most important test for low testosterone is your total blood testosterone level. If you are worried, you should see your doctor to talk about your symptom. During your consultation, your doctor will check the following:

  • Blood tests for testosterone level, other hormone levels, blood lipids, and a blood count for red blood cell level
    • Complete medical history, including diseases and medications
    • Complete physical exam including:
  • BMI or waist circumference for obesity
  • Metabolic syndrome (high blood pressure, high blood sugar, too much body fat around the waist, and high cholesterol levels)
  • Hair pattern, amount, and location
  • Enlarged breasts
  • Whether testicles are present and their size
  • Prostate size and any abnormalities

Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men. Doctors may prescribe testosterone as injections, pellets, patches or gels.

Can testosterone therapy promote youth and vitality?

Testosterone therapy can help reverse the effects of hypogonadism, but it’s unclear whether testosterone therapy would have any benefit for older men who are otherwise healthy. Although some men believe that taking testosterone medications may help them feel younger and more vigorous as they age, some scientific studies have demonstrated mixed results.

What are the risks and benefits of testosterone therapy?

Treating normal aging with testosterone replacement therapy (TRT) is not currently recommended by the government and some scientific organizations. Supporters of testosterone therapy for symptoms of low testosterone approach claim that testosterone is safe and has few side effects. There is already a large body and a growing body of scientific articles to support the health benefits of testosterone therapy.

Testosterone may have the following benefits:

  • Reduced or no increase in cardiovascular events in men with androgen deficiency
  • Improved cardiac function
  •  Improve serum glucose levels and HgbA1C.
  • Improve insulin resistance in men with diabetes and prediabetes.
  • Reduced intra-abdominal (visceral) fat, obesity, and fat mass and an increase in lean mass.
  •  Improve exercise capacity in patients with congestive heart failure.
  •  Low testosterone levels are associated with increased mortality.
  •  Mayo Clinic Proceedings (2016) states “There is no credible evidence at this time that testosterone therapy increases cardiovascular risk and substantial evidence that it does not. Indeed, there is a strong signal that testosterone therapy may offer cardiovascular benefits to men”
  • TRT for hypogonadism does not increase PSA or the risk of prostate cancer.
  • Testosterone therapy may increase red blood cells but there is no increase in venous thrombosis.

Testosterone may have the following risks:

  • Cause acne or other skin reactions initially
  • Temporary increase in fluid retention and/or leg swelling
  •  Cause enlarged or tender breasts if excessive testosterone
  •  Limit sperm production or cause testicle shrinkage

Talk to your doctor about testosterone therapy?

Treatment Steps

First talk to your provider about your concerns and whether they may be related to low testosterone. Undergo a careful evaluation which includes the following:

  • Make an appointment with a provider that is knowledgeable regarding testosterone. Talk openly about any possible symptoms that are bothering you and if they may relate to low testosterone.
  • Undergo a physical exam. Your health care provider will check your genitals, body hair, breasts, prostate, and other parts of the body for possible signs of testosterone deficiency. Other tests may be done to rule out alternative causes of any symptoms.
  • If your doctor feels that your symptoms may be related to low testosterone, a blood test for testosterone levels and possibly other related blood tests will be ordered. For accuracy and consistency, testosterone blood testing should be done in the morning. Repeat confirmation test for low testosterone at a later date is recommended to confirm low testosterone due to a possible lab error that should be done rather than relying on a single blood sample.
  • If your testosterone levels are clearly and consistently low, and you’re interested in treatment, discuss the risks, benefits and side effects with your doctor.
  • There are several treatment options available. Your provider will discuss the various options along with the relative risks and benefits. Choose the right form of treatment for you. Testosterone patches and gels are more successful in establishing relatively stable, normal levels. Injections are usually less expensive and usually paid by insurance. Injections are efficacious but testosterone levels go quite high after an injection peaking at levels above normal, then fall relatively quickly – frequently to levels that are below normal – prior to the next injection.

How will I be monitored while on testosterone replacement therapy?

Your doctor will measure your testosterone levels at the 3- and 6-month marks after treatment begins and then annually. If your levels are OK you’ll stay on your current dose. Your provider will monitor your response to treatment. If you are not obtaining any benefit from testosterone replacement then you should stop it. Your prostate, genitals, breasts, body hair, and possibly other areas may be examined. Testosterone may help osteoporosis which can be checked a year or so after treatment begins. Your red blood cell levels will be measured prior to treatment and periodically thereafter. Other periodic blood tests might include PSA tests, red blood cell counts, cholesterol and liver function tests.

If your testosterone levels are too low, your dose may be adjusted. Your doctor will evaluate your prostate cancer risk at the start of treatment and may do more tests at the 3- and 6-month marks, and then annually.

How long do I have to take testosterone replacement therapy?

Indefinitely as testosterone replacement does not cure low testosterone. Your symptoms may return if you stop taking it.

Thyroid

The thyroid is a gland located in the lower, front portion of the neck. The thyroid gland itself is controlled by another gland, pituitary, located in the brain. The thyroid gland secretes two thyroid hormones, mostly T4 (thyroxine) but also some T3. T3 is the active hormone that is used at the cellular level. T4 has to be converted first into T3. These hormones regulate the many expressions of the body’s metabolism.

The thyroid regulates many things in the body including temperature, metabolism, cerebral function, and energy levels. It also increases fat breakdown resulting in weight loss as well as lowering cholesterol. When functioning normally, it protects against cardiovascular disease, cognitive impairment, fatigue, weight gain, and memory loss.

Since T3 is so widely used in the body there are over 200 symptoms related to thyroid deficiency including weakness, coldness, tiresome, fatigue, thin hair, dry skin, thin nails, weight gain, increased body fat, loss of energy, loss of motivation, loss of cognition, loss of memory, mood disturbances, and a poor overall sense of well-being.

The symptoms of low thyroid vary widely but are notoriously for being nonspecific and mimicking many of the normal changes of aging. Frequently thyroid hormone levels fall slowly over time so the symptoms of low thyroid are slow in onset and insidious. Many times we attribute our symptoms to aging when in fact something can be done about it!

In order to customize thyroid replacement specific to you, we will measure your current level of thyroid hormones and will review your symptoms of possible thyroid depletion. This will include a complete history and physical examination. After we review the benefits and any possible side effects of treatment and if you are agreeable, we will begin treatment. Any other medications or medical problems will be taken into consideration. We will trend over time your thyroid levels with your response to treatment by following your symptoms of low thyroid until you are in proper balance.

We will continue to monitor you to minimize any possible side-effects from too little or too much thyroid and monitor you for any other related medical problems.

DHEA

Dehydroepiandrosterone (DHEA) is a hormone secreted primarily by the adrenal glands. DHEA itself is not felt to be active but it is a precursor to the active androgen hormones, testosterone and dihydrotestosterone. It results in a shift of a catabolic state to an anabolic or protein building state. By doing this it reduces cardiovascular risks by increasing lipolysis (decrease visceral fat). Studies suggest that it helps to stimulate the immune system, restore sexual vitality improves moods, decrease cholesterol and body fat. DHEA improves memory, increases energy, and is thought to have anti-cancer properties by enhancing the immune system. Declines in DHEA may contribute to loss of sleep, osteoporosis, and atherosclerosis.

Studies suggest that optimal DHEA levels reduce insulin requirement, play a role in restoring immunity, preventing osteoporosis, increasing bone density, prevent diabetes, prevent heart disease, decrease visceral fat, it can improve mood and a sense of well-being, improves energy and memory.

Most people do not need to supplement DHEA. In order to properly screen for potential benefit from DHEA replacement, we will measure your current level of DHEA hormones and will review your overall symptoms of health. This will include a complete history and physical examination. After we review the benefits and any possible side effects of treatment and if you are agreeable, we will begin treatment. Any other medications or medical problems will be taken into consideration. We will trend over time your DHEA levels with your response to treatment by following your symptoms until you are in proper balance.

We will continue to monitor you to minimize any possible side-effects from too little or too much thyroid and monitor you for any other related medical problems.

Human Growth Hormone

Human Growth Hormone (HGH) is a hormone excreted by the pituitary gland in the brain mostly during deep sleep.

HGH declines cause fatigue, poor muscle development, excessive body fat, decreased initiative, decrease endurance and strength, poor healing, decreased immunity, thin bones, sagging muscles, increased wrinkles, slow hair growth, sagging skin, breast, and abdomen.

Must document symptoms and ITT and IGF-1 levels to treat. IGF-1 to adjust the dose. Goal 300