Testosterone Treatments

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Caroline Davdige-Pitts, MD

Additional Resources
Mayo Clinic

American Urological Association

Low testosterone (hypogonadism) can be treated with the use of doctor-prescribed testosterone replacement therapy. This treatment is safe and can be effective for men who are diagnosed with consistently abnormal low testosterone production and symptoms that are associated with this type of androgen (hormone) deficiency.

While testosterone replacement therapy is the primary treatment option some conditions that cause hypogonadism are reversible without testosterone therapy. These should be addressed before testosterone therapy is contemplated. If testosterone therapy is needed, goal of treatment is to improve symptoms associated with testosterone deficiency and maintain sex characteristics. There are many different types of testosterone therapy. You should discuss the different options with your physician "your partner in care" to find out which therapy is right for you.

Testosterone Facts For Men

  • Low testosterone comes with age — Testosterone or "T" levels naturally decrease by 1% each year after age 30, though don’t severely deplete, even in advanced age
  • T production may be disrupted by disorders of the testicles, pituitary gland, or brain
  • T levels change from hour to hour — highest in the morning; lowest at night
  • T levels can temporarily lower due to too much exercise, poor nutrition, severe illness, and with certain medications
  • Normal T levels should be between 300–1,000 ng/dL (nanograms per deciliter), depending on age and lab used
  • Testosterone must be measured more than once for accurate assessment

Testosterone therapy is only recommended for hypogonadism patients. Boosting testosterone is NOT approved by the US Food and Drug Administration (FDA) to help improve your strength, athletic performance, physical appearance, or to treat or prevent problems associated with aging. Using testosterone for these purposes may be harmful to your health.

Male hypogonadism is a combination of low testosterone levels and the presence of any of these symptoms:

  • Drop in sex drive (libido)
  • Erectile dysfunction (ED — inability to get or keep an erection) and loss of spontaneous erections
  • Lowered sperm count and infertility (inability to have children)
  • Breast enlargement or tenderness
  • Reduced energy
  • Reduced muscle mass
  • Shrinkage of testes
  • Increased irritability, inability to concentrate, and depressed mood
  • Hot flashes (when testosterone levels are very low)

You should not receive testosterone therapy if you have:

  • Prostate or breast cancer (or suspected)
  • Enlarged prostate causing difficulty with urination
  • Elevated prostate specific antigen (PSA) levels
  • High number of red blood cells
  • Untreated sleep apnea (obstructed breathing during sleep)
  • Planningto have children
  • Heart attack or stroke within the last 6 months
  • Blood clots

Testosterone Therapies

Method of treatment depends on the cause of low testosterone, the patient’s preferences, cost, tolerance, and concern about fertility.

Injections. Self or doctor administered in a muscle every 1–2 weeks; administered at a clinic every 10 weeks for longer-acting. Side effects: uncomfortable, fluctuating symptoms.

Gels/Solutions. Applied to upper arm, shoulder, inner thigh, armpit. Side effects: may transfer to others via skin contact — must wait to absorb completely into skin.

Patches. Adhere to skin every day to back, abdomen, upper arm, thigh; rotate locations to lessen skin reaction. Side effects: skin redness and rashes.

Buccal Tablets. Sticky pill applied to gums twice a day, absorbs quickly into bloodstream through gums. Side effects: gum irritation.

Pellets. Implanted under skin surgically every 3–6 months for consistent and long-term dosages. Side effects: pellet coming out through skin, site infection/ bleeding (rare), dose decreasing over time and hypogonadism symptoms possibly returning towards the end of dose period.

Nasal Gel. Applied by pump into each nostril 3x a day. Side effects: nasal irritation or congestion.

Risks of Testosterone Therapy

  • Elevated red blood cell count
  • Acne
  • Sleep apnea
  • Possible prostate and/or breast enlargement

There is no firm scientific evidence that long-term testosterone replacement is associated with either prostate cancer or cardiovascular events. The FDA requires that you are made aware that the possibility of cardiovascular events may exist during treatment. Prostate cells are stimulated by testosterone, so be extra vigilant about cancer screenings. African American men over age 45 — especially those with family history of cancer — are already at risk for prostate cancer.

Hypogonadism is a common condition in the male population, with a higher prevalence in older men, obese men, and men with type 2 diabetes. If you are concerned about your testosterone levels It is important to talk to doctor about ways to manage.

Questions to Ask Your Doctor

  • Do I have hypogonadism?
  • Is the problem with my testes?
  • Is there anything I can do to improve my testosterone levels without taking testosterone therapy?
  • What are the risks and benefits of testosterone therapy?
  • What are the different types of testosterone therapy?
  • What follow up screening will I need?
  • Should I see a male reproductive specialist (urologist)?

Edited: March 2018