Testosterone levels are measured with a simple…
Low testosterone can be treated if is…
Testosterone replacement therapy can restore…
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Our Low Testosterone Specialists
Dr. Korman, Howard
Dr. Kearney, David
Testosterone is a hormone that is made primarily in a man’s testicles. Your brain keeps track of how much testosterone is in your blood and tells your testicles when it’s time to make more.
Testosterone is responsible for many male physical characteristics like body and facial hair. It also plays a role in:
- a man’s sex drive
- sperm production (which can lead to Male Infertility issues)
- muscle mass and bone density
- energy level
- a man’s emotions and sense of well-being
Low testosterone can be treated if is causing symptoms including:
- Decreased interest in sex
- Trouble getting or keeping an erection
- Trouble getting a woman pregnant because of low sperm count
- Increase in breast size and body fat
- Feelings of irritability, anger or depression
- Trouble concentrating
If the loss of testosterone is severe, it can cause a loss of body hair, a reduction in muscle mass and smaller, softer testicles. It can also cause reduced bone density, which can increase your risk of osteoporosis.
Your doctor may order these blood tests:
- Total testosterone level. This test should be done at two different times on samples taken before noon. Testosterone levels are lower later in the day. If you are ill, the doctor will wait until you are not sick because your illness may cause a false result.
- Luteinizing hormone (LH). This test is done to help find the cause of a Low-T level. This hormone controls how you make testosterone. Abnormal levels may mean a pituitary gland problem.
- Blood prolactin level. If your prolactin level is high, your doctor may repeat the blood test to make sure there is no error. High prolactin levels also may be a sign of pituitary problems or tumors.
- Blood hemoglobin or Hgb. Before doing this test, your doctor will look for other reasons for low Hgb such as climate level (like climate altitude), sleep apnea, or tobacco smoking.
The following also may be done to help with further diagnosis:
- Follicle stimulating hormone (FSH). This test is to check for sperm-making function if you want to have children. You may also need to have semen tests. These tests will be done before any hormone therapy.
- Estradiol hormone test is done if there are breast symptoms.
- HbA1C blood test may be done for diabetes.
- MRI ( magnetic resonance imaging) of the pituitary gland
- Bone density tests.
You may hear about free testosterone or bioavailable tests for testosterone. These are not the same as total testosterone level tests. Ask your doctor about the differences and if you need these tests.
In recent years, the media has reported more about Testosterone Therpy (TT), and more men between the ages of 40 and 64 have been tested and given TT. Some men with certain symptoms may even want TT without being tested. This action may not be safe or helpful for them. Total testosterone level should always be tested before any TT.
The AUA recommends that TT be prescribed only to men who meet the clinical and laboratory definition of testosterone deficiency (Testosterone level of less than 300 ng/dL). Here are some of the things you will need to know about TT:
- Your doctor will likely measure your testosterone level if you have these conditions:
- Unexplained anemia
- Bone density loss
- Low-trauma bone fracture
- Radiation to your testicles
- HIV/AIDS positive test results
- Chronic narcotic use
- History of infertility
- Pituitary gland disorders
- Even if you do not have specific signs and symptoms, your doctor may test your total testosterone level for these conditions:
- Insulin resistance
- History of chemotherapy
- History of using corticosteroid medicines
- Health changes such as losing weight and getting more physical activity will likely raise your testosterone levels.
- Your doctor will want to check your hemoglobin/hematocrit (Hgb/Hct) levels while you are on TT. This blood test will help check for thickening of the blood.
- Blood thickening may cause blood clots. Your doctor may do Hgb/Hct levels two to six weeks after you start TT and every six to twelve months after that test.
- If you are at risk for heart disease, your doctor will follow you more closely when you are on TT. It also is important to make health changes to decrease the chances for heart and blood vessel disease.
- Your doctor will treat your Low-T level to raise it above 300ng/dl but the exact level may vary.
- Your doctor will watch you for signs and symptoms of improvement. Any changes will likely appear within three to six months of treatment.
- If your total testosterone blood level returns to normal and you still have symptoms, it is likely that there are other reasons for your symptoms. Your doctor may stop TT and try to find out what else might be the problem.
How Do I Take Testosterone?
There are generally five different ways to take testosterone. They are: transdermal (through the skin), injection, oral/buccal (by mouth), intranasal (through the nose), and by pellets under the skin. No method is better than another. While you are taking TT, your doctor will test your blood to determine testosterone levels.
Here are some details about the five different methods:
- Transdermal (Topical). There are topical gels, creams, liquids and patches. Topical medicines most often last for about four days. They absorb better if covered with an air- or water- tight dressing.
- Apply liquids and gels, creams or patches to skin that is dry and without cuts or scratches.
- Do not wash the area until it is time for the next dose.
- Wash your hands after you apply liquids, gels or creams.
- Make sure that other people, especially women and children, do not touch the medicines.
A topical patch is like a band-aid with medicine on it. You put it on and leave it until the next dose is due. The medicine on the patch is less likely than liquids, gels and creams to transfer to others.
- Injection. There are short-acting and long-acting forms of testosterone injection. The short-acting medicine may be given under the skin or in the muscle. The long-acting one is usually given in the muscle. Injections are usually given either weekly, every two weeks, or monthly.
- Oral/buccal (by mouth). The buccal dose comes in a patch that you place above your incisor (canine or “eyetooth”). The medication looks like a tablet but you should not chew or swallow it. The drug is released over 12 hours. This method has fewer harmful side effects on the liver than if the drug is swallowed, but it may cause headaches or cause irritation where you place it.
- Intranasal. This form of testosterone comes in a gel. You pump the dose into each nostril, as directed. It is usually taken three times daily.
- Pellets. Your doctor will place the testosterone pellets under the skin of your upper hip or buttocks. Your doctor will give a shot of local anesthesia to numb your skin, then make a small cut and place the pellets inside the fatty tissues underneath your skin. This medication 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. Talk about the choices with your doctor.
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.
If you are overweight, try to work on keeping your weight within recommended ranges. Increasing physical activity may help you lose weight and also may help increase testosterone levels.
Frequently Asked Questions
The primary cause of erectile dysfunction is usually not low testosterone but rather a blood flow problem caused by high blood pressure, diabetes and stiff artery walls. Correcting testosterone levels alone will not fix erectile dysfunction that is caused by blood flow issues.
Once a man starts taking testosterone replacement therapy, he needs to continue taking it because his body does not make enough of the hormone on its own. Furthermore, production of testosterone by the testes will decrease over time when a man takes TRT because his brain senses enough testosterone is already circulating in the body.
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