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    • Urinary Incontinence
    • Neurogenic Bladder
    • Benign Prostatic Hyperplasia (BPH)
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    • Vasectomy
    • Vasectomy Reversal
    • Interstitial Cystitis
    • Voiding Dysfunction
    • Female Urology
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    • Low Testosterone
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Low Testosterone

There are at least 4 million adult men in the United States who have low testosterone. Approximately 5 percent of these men are actually receiving treatment for this condition. Low testosterone can manifest itself by a few key symptoms including low libido, decreased energy, decreased frequency of erections, decreased enjoyment of life, decreased ability to concentrate and decreased sports performance. In addition to these symptoms, testosterone deficiency can lead to loss of bone mineral density (osteopenia), anemia, decreased cognitive function, decreased muscle mass and other important physiologic conditions. Testosterone deficiency is highly associated with multiple disease states including obesity, diabetes, hypertension, high cholesterol and asthma.

Low testosterone is diagnosed by a blood test. Physicians look for the level of testosterone, the level of albumin (a carrier protein for testosterone) and the level of sex hormone binding globulin (SHBG), a protein that tightly binds testosterone and makes it unavailable for use by the target organ, in the serum. From these lab tests, physicians can calculate the bio-available amount of testosterone. This is important because some men, especially older and heavier men, will have a normal serum level of testosterone but will have a low bio-available testosterone. In that case, they would benefit from testosterone replacement therapy. Physicians will also likely check a PSA (a screening test for prostate cancer) and a hematocrit (a measurement of red blood cells in your body). PSA testing allows for a baseline level and a determination of one’s risk of prostate cancer as men with active prostate cancer need to undergo treatment prior to initiating testosterone therapy. A hematocrit is checked because testosterone replacement therapy can increase this level.

Testosterone replacement therapy (TRT) can be administered in many forms. Oral forms are available but not widely used in the United States due to an increased risk of liver problems. Most physicians choose transdermal (TD) application routes to start. The most common form is a gel that is applied to clean dry skin every day at the same time, usually after a man gets out of the shower. TD application is easy, well-tolerated, allows for excellent absorption of testosterone and also allows for an even delivery of testosterone on a daily basis. There are minimal side effects; some men will have a mild skin irritation while others may see an increase in their hematocrit which will then to be monitored. Most insurance carriers will pay for at least a percentage of the medicine.

Injection therapy is another viable option. This involves the injection of testosterone on either a bi-monthly or weekly basis. The injections will give a high concentration of testosterone for the first few days and will decline to a low level after 10-12 days. It is a very effective therapy but it does require the patient or patient’s partner to learn how to inject or make frequent office visits.

Once starting TRT, patients should notice improved energy levels, exercise tolerance, libido and erectile function within the first few weeks of therapy. Optimal results will be achieved within about 3-6 months. Patients will return for an office visit 4-6 weeks after the first dosing to ensure adequate serum levels. Once a good regimen has been established, blood work should be checked periodically.

It is important for men with low testosterone to realize that while TRT is an important part of their overall health, following a good exercise regimen and diet is even more important. TRT patients who exercise and eat well will see the most improvement in their well-being.