Testosterone Replacement Therapy: Restoring Your True Virility

Men with a low sex drive, fading energy, mood changes, and erectile dysfunction may have low testosterone levels, also known as low T. However, these symptoms can be caused by other reasons (multi-factorial).

This article is for patients diagnosed with hypogonadism who are considering testosterone replacement therapy. It explains what this involves and outlines the risks and benefits.

What is low T or hypogonadism?

During puberty, the male sex hormone, testosterone helps boys develop male physical features like body and facial hair, deeper voices, and muscle strength. It is a hormone produced by the testes and is regulated by the pituitary gland and hypothalamus in the brain. Testosterone is also needed for men to make sperm.

When a man does not have enough testosterone in his body it is called low-T. Levels of the hormone normally decrease with age. About 4 out of 10 men over the age of 45 have low testosterone. It is seen in about 2 out of 10 men over 60, 3 out of 10 men over 70, and 3 out of 10 men over 80 years old. Men with certain health problems, including diabetes and obesity, also tend to have low testosterone.

You may have low T if you have the following:

• anemia (low iron);
• depressed mood or irritability;
• fewer and weaker erections;
• less energy;
• less muscle mass and strength;
• loss of calcium from bones;
• low sex drive;
• more body fat.

If you think you may have low-T, it is important to see a doctor and make sure you have low-T and not another condition. Many of the symptoms of low-T can be the result of other health problems. Diagnosis of low-T begins with a review of your medical history, a physical exam, and blood work to measure your testosterone levels.

If the symptoms of low-T are bothering you, talk to a doctor about whether or not you are a candidate for testosterone replacement therapy (TRT).

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Low T is also called hypogonadism. Hypogonadism is a lack of the male sex hormone testosterone and affects about 5 in every 1000 men. Testosterone is required by all men for a healthy life, physically and psychologically.

Hypogonadism in men can be due to a problem with the testes themselves or the pituitary gland or hypothalamus. This includes disorders of the testes such as Klinefelter’s syndrome (a genetic disorder), inflammation of the testes (orchitis), radiation or chemotherapy, and alcohol abuse.

Removal of both testicles, injury to both testicles, and undescended testicles are all causes of hypogonadism. Any disease of the pituitary gland or hypothalamus can also result in hypogonadism.

What are the symptoms of hypogonadism?

The symptoms may include:

• fatigue and lethargy;
• depression, anxiety, irritability;
• reduced sex drive, erectile dysfunction;
• decreased shaving frequency because of less hair growing on the face;
• reduced exercise tolerance and strength;
• excessive sweating and night sweats;
• poor concentration and/or memory.

What are the long-term risks of hypogonadism?

Osteoporosis (brittle bones) can occur, leading to an increased risk of hip and spine fractures.

How is hypogonadism treated?

Treatment is aimed at restoring normal levels of testosterone to improve well-being, sexual function, and quality of life and to prevent the development of osteoporosis. There are now several preparations for testosterone available, all of which require a doctor’s prescription.

What investigations will I have during TRT?

1. Blood tests to check the level of the hormones that are controlled by the pituitary.
2. You may need a special test to measure some of the pituitary hormones before and after
   stimulation to find out which are working normally and which are not.
3. Visual field check. The optic nerve, which relays images from your eye to your brain, passes
   very close to the pituitary gland. Tumors of the pituitary gland can expand causing pressure on this nerve and this will cause impaired vision initially involving the periphery (edge) of the vision. This is checked by a special computerized light screen. Dots of light appear on the screen and the patient has to identify when they see them.
4. Special scans such as MRI can detect the site and extent of the tumor and any pressure on
   the surrounding structures.

What are the side effects of testosterone replacement therapy?

Occasional side effects include:

• spots, usually on the back or chest;
• prolonged painful erection;
• thickening of blood by overproduction of red blood cells;
• aggression;

There is no conclusive evidence to link testosterone treatment to an increased risk of prostate cancer but monitoring your PSA level (a marker of prostate cancer) is still recommended.

We prevent possible side effects by using an additional safe medication, regular monitoring, and dosage adjustments.

Whichever type of testosterone replacement therapy you take, you will need blood tests at regular intervals to check testosterone levels and ensure you do not develop potentially serious side effects of treatment.

How is the treatment monitored?

1. Baseline blood tests would be done before starting the treatment. These include full blood
   count, PSA, liver function, testosterone, and lipid profile.
2. You will be reviewed in three months, and then every year. Your review will include
   checking on your symptoms and looking at any potential side effects of the therapy. You will
   also have regular checks, including a full blood count, PSA, lipid profile, liver function,
   testosterone levels, and blood pressure. The doctor may also examine your prostate gland via
   a rectal (back passage) examination.

Who should not take TRT?

Men with an untreated heart problem, sleep apnea, or a history of elevated red blood cell count should not take TRT, as testosterone could worsen these conditions. Men with prostate or breast cancer should carefully use TRT for the same reason.

Do not take TRT for non-medical reasons, such as bodybuilding, preventing aging changes, or performance enhancement if your testosterone levels are normal. Men who have normal testosterone levels will not be helped by TRT.

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