Hormone Replacement for Men
Testosterone is an androgen indicated as a treatment for replacement therapy in men with symptoms of low testosterone levels in the body or absence of endogenous testosterone. It is a sexual hormone produced by the testes and it encourages the development of male sexual characteristics.
Why men need testosterone?
Proper levels of the hormone are beneficial to men’s health. Healthy levels of the hormone promote good health while lowering the dangers of high blood pressure and heart attack, in addition to a heart-healthy diet. Still, testosterone may be given as a treatment for specific medical conditions and low levels of testosterone in both men and women.
Some men have low testosterone levels. This is called testosterone deficiency syndrome (TD) or low testosterone (low T). Deficiency means that the body does not have enough of a needed substance. A syndrome is a group of symptoms that, together, suggest a disease or health condition.
The American Urology Association (AUA) identifies low blood testosterone as less than 300 nanograms per deciliter (ng/dL). The following symptoms or conditions may accompany the low T:
- low sex drive;
- reduced lean muscle mass;
- erectile dysfunction;
There are many other possible reasons for these symptoms, such as opioid use, some congenital conditions (medical conditions you are born with), loss of or harm to the testicles, diabetes, and obesity (being overweight).
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 60 years old may have TD. People who study the condition often use different cut-off points for the numbers, so you may hear different numbers being stated.
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.
Although many symptoms may be tied to low testosterone, total blood testosterone level is the most important measure of testosterone deficiency. To make a diagnosis, a doctor will use other specific signs and symptoms in addition to your testosterone blood level.
At your medical visit, your health history will be taken, and the doctor will do an exam and look for some of the signs and symptoms.
A doctor may ask you about:
- Headache, visual field change (possible symptoms of brain mass such as a pituitary tumor)
- How you developed at puberty
- History of head trauma
- Cranial (head) surgery/brain tumor or cranial irradiation
- Anosmia (loss of ability to smell)
- History of infection in your testicles
- Injury to your testicles
- Mumps after puberty
- The past or present use of anabolic steroids
- Use of opiates
- Use of glucocorticoids (medicines, such as cortisone, used to treat inflammation)
- History of chemotherapy or irradiation
- Family history of diseases linked to low T
- History of stroke or heart attack
- History of unexplained anemia
A doctor will check for the following:
- BMI or waist circumference for obesity
- Metabolic syndrome. These are symptoms (seen together) of increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels
- Hair pattern, amount, and location
- Gynecomastia (enlarged breasts)
- Whether testicles are present and their size
- Prostate size and any abnormalities
A 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.
What is hypogonadism?
Hypogonadism is an extreme deficiency of testosterone in the blood. There are 2 types of hypogonadism distinguished:
- Primary hypogonadism (congenital or acquired) – testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome; or orchidectomy.
- Hypogonadotropic hypogonadism (congenital or acquired) – gonadotropin or LHRH deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation.
More men between the ages of 40 and 64 have been tested and given TRT. Some men with certain symptoms may even want TRT without being tested. This action may not be safe or helpful for them. Total testosterone level should always be tested before any TRT.
According to AUA, testosterone replacement therapy (TRT) is indicated for men with the clinically diagnosed hypogonadism confirmed by the lab evaluation showing lowered levels of T-hormone or the diagnosis called the testosterone deficiency or low T (testosterone level of less than 300 ng/dL).
Bioidentical testosterone used for TRT is available under the following different brand names: Aveed, Depo-Testosterone, Delatestryl, and Testopel.
How do I take testosterone?
There are generally five different ways to take testosterone. They are such as transdermal (through the skin), injection, oral/buccal (by mouth), intranasal (through the nose), and by pellets under the skin. While you are taking TRT, a doctor will test your blood to determine current testosterone levels.
The dosages indicated for adults within the testosterone replacement therapy are as follows:
- testosterone cypionate: 50-400 mg IM every 2-4 weeks;
- testosterone enanthate: 50-400 mg IM every 2-4 weeks;
- testosterone undecanoate (restricted availability): 750 mg IM initial dose, repeat after 4 weeks, and then q10wk thereafter;
- pellet: 150-450 mg SC every 3-6 months; 150 mg of pellet approximately equivalent to 25 mg of testosterone propionate weekly.
If you’ve got more questions concerning the types of the drug, the difference between the types of TRT, and the effectiveness of the therapy, please contact our medical expert and get a free consultation.