What is “Low T”?
Low Testosterone, commonly known as “Low T” or hypogonadism, refers to a decrease in a man’s testosterone levels causing unwanted symptoms. This can be attributed to problems with testicular production (primary hypogonadism) or with the pituitary gland (secondary hypogonadism). As men age, 1-2% of total testosterone is lost each year starting in the 3rd or 4th decade of life. Low T can lead to bothersome symptoms such as fatigue, weight gain, low sex drive, and erectile dysfunction (ED).
How Low T impacts Erectile Function
Erectile function is testosterone dependent. It is important to note, however, that not all men with ED suffer from Low T or vice versa. Furthermore, not all men with Low T and ED improve after replacement of testosterone to optimal levels.
Men may need to combine TRT with oral ED meds for optimal sexual function
Confused yet? I don’t blame you. With years of research, we now know there is a complex interplay between Low T and ED. Testosterone replacement therapy (TRT) for men with Low T will often improve ED, low sex drive, and other bothersome symptoms, however, if erectile function does not improve significantly, men may need to combine TRT with oral ED medications for optimal sexual function.
Causes of Low Testosterone
There are multiple possible causes of Low T including aging, stress, obesity, diabetes, sleep apnea, HIV/AIDS, testicular injury, infection, chemotherapy or radiation to the pelvis, and chromosomal abnormalities. Oftentimes, the cause is unknown.
TRT can dramatically improve quality of life
Regardless of cause, the symptoms of Low T can be quite debilitating. Testosterone replacement therapy can dramatically improve quality of life and can be used in a safe and effective manner. Improvements can be seen quickly, including strengthened bones, improved muscle mass, increased energy, improvements in erection quality, mental clarity, and fat loss. There is also new evidence that optimal testosterone levels can help prevent some chronic conditions such as hypertension, diabetes, and heart disease.
Low T Impacts Sex Drive
Low T almost always leads to a decrease in a man’s sex drive, or libido. A thorough history and physical exam from a physician who specializes in TRT, such as a Urologist, is essential to work through possible causes of a sudden loss of sex drive. Besides Low T, other conditions that could affect sex drive include thyroid disorders, sleep apnea, and (rarely) benign tumors of the pituitary gland.
Treatment Options for Low T
There are many forms of testosterone replacement available to men with Low T. Options include nasal sprays, topical creams or gels, intramuscular (IM) injections, and subcutaneous pellets.
Topical therapy is a simple way to replace testosterone daily without using needles or undergoing an in-office procedure. Care must be taken not to transfer the cream or gel after application via skin-to-skin contact to women or children.
Patients who are comfortable with needles are taught how to do the intramuscular injections in their physician’s office. The patient administers the treatments at home every 1-2 weeks depending on their doctor’s orders. There is no threat of transfer of the hormones to others with this treatment option.
Lastly, testosterone pellets are a longer-lasting injection therapy. Pellets are implanted under the skin in a quick office procedure. The therapy lasts for about 6 months and can minimize the roller coaster highs and lows some patients experience with IM injection therapy.
If You Want to Have Children
Talk with your physician if you are planning to have children. TRT causes infertility for a period of time, as exogenous testosterone suppresses your body’s ability to make viable sperm. Additionally, there is no guarantee fertility will be restored when you stop TRT. If you are of childbearing age, please speak with your physician about risks and benefits before starting any form of testosterone supplementation.
Men of childbearing age may be better suited to HCG and SERM
Human Chorionic Gonadotropin (HCG) and Selective Estrogen Receptor Modulators (SERM) are alternatives to TRT that can be prescribed to preserve fertility. An example of a SERM is the medication Clomid® (Clomiphene Citrate). Men of childbearing age with Low T may be better suited to these types of supplementation. After childbearing, a transition to TRT creams, injections, or pellets can then be made.
Possible side effects may include increased red blood cell count, worsening of urinary function, male-pattern balding, acne, and mood swings. There are also theoretical risks of cardiac issues or blood clots. If you have pre-existing cardiac risk factors, make sure to discuss this with your physician before starting TRT.
While on TRT, men must comply with a series of lab tests to ensure their testosterone level is on-target and other blood chemistries remain normal. Liver function tests, cholesterol panels, PSA for prostate cancer screening, and complete blood counts are closely monitored to help prevent any possible side effects of TRT.