Hypogonadism or Low Testosterone

What is Testosterone?

Testosterone is the sex hormone that helps in the development of male physical features and helps boys become men during puberty. Testosterone levels are also active in a man’s body throughout life. Testosterone levels affect a man’s sex drive, erections, mood, exercise tolerance, mental stamina, muscle mass, bone density, and vascular health. A healthy testosterone level is an important component to a man’s overall health.

What is a Normal Testosterone?

A man’s testosterone can be normal within a broad range. Testosterone is measured in the blood usually in ng/ml and in healthy young men can range between 300-900. Testosterone levels tend to be lower on average in men as we age, with average testosterone levels for healthy men still in the 300-600 range for older men.

A “normal” levels of testosterone, however, can vary from man to man. A level of 250 ng/ml in one man may not cause any symptoms while in another man this may cause fatigue, lower libido, and mood changes. The variability in what is normal makes testosterone deficiency difficult to diagnose and can be difficult to treat.

What is Hypogonadism or “Low-T”?

Some men have low levels of testosterone. This is called hypogonadism, or low-T. Men with low-T have problems such as: reduced sex drive, fewer and weaker erections, less energy, depressed mood or irritability, less energy, decreased tolerance for exercise or hard work, less muscle mass and strength, more body fat, osteoporosis or osteopenia, and have an increased risk of diabetes and heart disease.

There is no absolute standard of “low-T”. The American Urological Association guidelines suggest a level of 300 ng/ml or less as a good standard to determine a low testosterone level for men with some or all of the symptoms or signs of testosterone deficiency.

The symptoms of low testosterone are very subjective, and men with normal or high normal levels of testosterone can have depression, low sex drive, and low energy levels. Those men usually do not get any improvement over the long run with testosterone replacement. Furthermore men with diabetes, obesity, and heart disease don’t automatically become fit and strong simply by increasing testosterone levels. Diet, exercise, and a healthy lifestyle play a role in overall health (and can increase testosterone levels by adhering to them) far more significant than any medication or testosterone supplement.

Above are the AUA guidelines regarding Evaluation and Management of Testosterone Deficiency. You can download or scroll through the guidelines by clicking on the picture above or find more at this LINK HERE.

What is Testosterone Replacement Therapy (TRT)?

Testosterone replacement therapy (TRT) is approved by the FDA to treat men with hypogonadism (low-T). It most often comes in the form of gels, patches, injections (shots), and pellets placed under your skin. Testosterone replacement can be considered for men with low levels of testosterone confirmed by testing and the symptoms of low-T.

What should you know about Testosterone Replacement Therapy?

Men should not take testosterone for non-medical reasons, such as body building, preventing aging changes or performance enhancement.

Men should not take testosterone replacement if they have normal testosterone levels or if their testosterone levels have not been tested.

If you are trying to father a child, you should know that testosterone replacement can decrease your sperm count and fertility.

Many of the symptoms for low-T can be the result of other health problems. Please see your primary physician to evaluate for other health issues such as diabetes, sleep disorders, depression, and obesity prior to evaluation by a urologist.

Side effects of testosterone can include: acne (pimples),breast swelling or soreness, a high red blood cell count, swelling of the feet or ankles, smaller testicles, infertility, mood variability and aggressive behavior.

If your doctor prescribes TRT, you should have regular check-ups. Your doctor should follow-up with blood tests for testosterone level, PSA and hematocrit. (PSA is a test for prostate issuesincluding prostate cancer. Hematocrit tests yourred blood cell count.) Based on your health history, your doctor may want to follow up with other tests.

Medical science cannot say for certain whether testosterone replacement increases your risk of prostate cancer or heart disease in the future.

One last comment about Testosterone Replacement Therapy

Many men and primary physicians rely on the urologist to diagnose and treat low testosterone. This is both good and bad for men. Urologists are uniquely qualified to talk to men about testosterone given we also treat erectile dysfunction, prostate health, infertility, and other aspects of sexual dysfunction.

Urologists, however, rely heavily on specialties such as primary care, endocrinology, cardiology, obesity specialists, physical therapist and even athletic trainers who are better trained to tackle obesity, diabetes, high blood pressure, sleep apnea, heart disease, physical limitations and injuries related to exercise.

TRT can give a man’s health a small boost, but it can’t overcome a poor diet and unhealthy lifestyle.