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August 2, 2011

Treatment for a Low Testosterone Level

If you’re a middle age male and are experiencing declining sexual performance, decreased sex drive, low energy, are gaining weight especially around the belly, seem more irritable, and not on top of your game mentally, there’s a good bet that you have a low testosterone level.

There’s good news, though.  You don’t have to live with a low testosterone level.  The first thing to do is to get evaluated by a physician, and preferably one very familiar with hormone replacement.  What a normal or healthy testosterone level is varies from person to person.  Many physicians rely solely on blood testosterone levels to make a diagnosis of low testosterone without taking into account one’s symptoms.  The diagnosis of low testosterone should be based on signs and symptoms in conjunction with blood testosterone levels.

I Have a Low Testosterone Level

Many effective treatments for low testosterone now exist. Testosterone preparations are available in injectable form, topical patches, gels and creams, and pellets either implanted under the skin or through adherence to the gums.  All of these preparations have the ability to reduce sperm counts.

Each testosterone delivery system has its advantages and the method of treatment is primarily personal preference.  Testosterone intramuscular injections have been the gold standard, and many physicians feel that better blood levels can be obtained with intramuscular injections. Topical preparations are beginning to be used more and more, but absorption through the skin is variable and can be affected by many things. In addition, transference of testosterone to another person can happen from skin to skin contact.

For men with low testosterone who wish to maintain optimal fertility HCG, or human chorionic gonadotropin can be given, though not all men are candidates for HCG treatment.  HCG is an analog of luteinizing hormone, or LH, which stimulates the testes to produce testosterone.  The LH level can be used to identify males that are more likely to benefit from HCG.  The lower the LH level the more likely a male will respond to HCG and produce more testosterone.  HCG is usually given in an injection form into the subcutaneous fat of the belly.

Monitoring Treatment for a Low Testosterone Level

It’s important to be monitored closely by your physician if you are being treated for low testosterone.  Treating low testosterone is safe, but there are some potential risks and side effects.

Testosterone increases oil production of the skin and can lead to acne.  Skin irritation can occur from topical creams, gels, and patches.  Testosterone can lead to shrinkage or atrophy of the testes in about 10% to 12% of males.  This does not pose any health risks and is more an aesthetic concern.  Testosterone stimulates the bone marrow to produce red blood cells.  In some cases the hematocrit, an indicator of red blood cell numbers, can become too elevated (erythrocytosis) potentially making the blood too thick.  This can be managed by donating blood, or if necessary decreasing the dose of testosterone.  Erythrocytosis is more likely with injectable testosterone.  As mentioned already, testosterone replacement can reduce fertility.  Fluid retention can occur in a small number of men, too.

Some testosterone gets converted or metabolized into other hormones like dihydrotestosterone (DHT) and estradiol.  Excessive DHT can lead to thinning of the hair, and excessive estradiol levels can cause breast/nipple enlargement, swelling, or tenderness (gynecomastia).  Sometimes an adjustment in the testosterone is all that is needed to address this, but other medications are available to lower DHT (5 alpha reductase inhibitors) and estradiol (aromatase inhibitors) if necessary.

It was long thought that testosterone might cause prostate cancer, but that has been shown in multiple studies to not be the case.  A study published in Journal of Urology in April, 2011 reported no progression of untreated prostate cancer in a group of 13 men who were treated for their low testosterone. The men were followed for an average of two and half years.  The study concluded testosterone therapy in men with untreated prostate cancer was not associated with prostate cancer progression in the short to medium term.  Other studies have shown that men with low testosterone get more aggressive prostate cancers.

For a vast majority of men the benefits of treating a low testosterone level outweigh the potential risks and side effects.  If you think you have a low testosterone level seek help.

See related articles.

“What are the Risks of Male Hormone Therapy?”

“Androgen Replacement Therapy”

“Normal Testostereone Levels?”

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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