Low Testosterone
Table of Contents
The male sex hormone that is primarily made in the testicles is called testosterone. These hormone levels are important to normal male sexual development and functions. As a man ages, his hormone levels commonly decrease. This is known as Low T and may be more common among men who are overweight or have diabetes. Testosterone therapy can bring hormone levels back to normal.
Symptoms of Low T
Common symptoms of Low T include:
- Low sex drive
- Fatigue
- Reduced lean muscle mass
- Irritability
- Erectile dysfunction
- Depression
- Loss of body hair
However, these symptoms could also signal other issues so it’s important to get checked.
Causes of Low T
Some conditions from birth can cause Low Testosterone such as:
- Klinefelter syndrome
- Noonan syndrome
- Ambiguous genitalia (when the sex organs develop in ways that are not typical in appearance)
In other cases, these could be the cause:
- Primary hypogonadism (testicular disorder)
- Secondary hypogonadism (pituitary/hypothalamus dysfunction)
- Damage to testicles due to trauma
- Removal of testicles because of cancer
- Chemotherapy or radiation therapy
- Pituitary gland disease leading to hormone deficiency
- Infection
- Autoimmune disease
Diagnosing Low T
During your visit your doctor will ask about your medical history and conduct a general exam.
Common methods of diagnosing Low T include:
- Blood test to measure your testosterone level. Testosterone levels are naturally lower later in the day so physicians typically suggest testing on two different days, both before 10 a.m.
- BMI (body mass index) or waist circumference measurement
- Possible metabolic syndromes that can cause increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels
- Hair loss
- Enlarged breasts
- Size of testicles
- Prostate size and any abnormalities
Treating Low T
Despite advertising, we do not recommend Testosterone Replacement Therapy (TRT) unless it is medically necessary. Taking testosterone may not be safe, and it may not be helpful. TRT should only be prescribed for men who meet the clinical and laboratory definition of testosterone deficiency (testosterone level of less than 300 ng/dL). To determine if TRT is right for you, your doctor will:
Measure your testosterone level. These conditions could affect your levels:
- Unexplained anemia
- Diabetes
- 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
If your doctor prescribes TRT, here’s what you should know:
- There are multiple ways to take testosterone.
- No method is necessarily better than another.
- While you are taking TRT, your doctor will test your blood to determine your response to treatment.
Here are some details about the five different methods for taking TRT:
- Transdermal (topical): Gels, creams, liquids, or patches deliver testosterone through your skin.
- 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: One option is to place a patch above your incisor tooth. The drug is released over 12 hours. It may cause headaches or cause irritation where you place it. There are also newer FDA approved pill forms of testosterone.
- 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 may place the testosterone pellets under the skin of your upper hip or buttocks. First your skin will be numbed. Then a small cut is made, and the pellets are placed inside the fatty tissues underneath your skin. The pellets dissolve slowly, and the medication 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 for your lifestyle. In some cases, your insurance provider may decide the order in which testosterone therapies are provided. Talk about the choices with your doctor.
