Testosterone Replacement for Men
Testosterone, the primary hormone produced by the testicle, promotes most of the masculine characteristics of the body. These ’secondary sexual characteristics’ include development of the penis, increased muscle strength and mass, facial and body hair and male sexual function. There are many medical conditions in men that result in low testosterone levels, a condition known as hypogonadism. Hypogonadism can cause symptoms such as loss of energy, depression, thinning of the bone (osteoporosis), loss of sexual interest and function and muscle wasting. Men are less likely than women to be evaluated for osteoporosis. Osteoporosis increases the risk of hip fracture which has a mortality rate of 30% during the first year. For that reason screening for low testosterone and associated osteoporosis before a fracture occurs can result in life saving treatment.
Trauma to the testicles such as sports injuries or mumps, tumors of the pituitary gland or simply prolonged and severe illnesses can all cause low testosterone levels. Testosterone levels in men typically decline with aging and by the age of 60 about 20% of men have low testosterone levels. Hypogonadism developing due to aging is sometimes called ‘andropause’. The first challenge for those suffering from a low testosterone level is to have the condition properly diagnosed since symptoms are non-specific and may be attributed to age alone. Diagnosing low testosterone can usually be done with a simple blood test. Doctors disagree about the best test to use for diagnosing low testosterone but in general the total or free testosterone level (not bound to a carrier substance in the blood) or both together, are the most frequently used.
Once a low testosterone level is detected and if there is no reversable cause of this problem then testosterone replacement is generally advised. The use of an injection to administer testosterone has been the most commonly used method until the last decade or so. Testosterone containing patches and gels have been developed that can be applied to the skin. The hormone is then absorbed through the skin into the blood stream. Although testosterone can be taken by mouth this method is not advised due to the risk of liver toxicity.
Among the first preparations designed for skin application was Testoderm which employs a testosterone containing patch applied directly to the testicle. Due to inconvenience and discomfort this product has not been very popular. Another patch is Androderm which can be placed on any area of skin on the body which is free of hair. The adhesive on the patch occasionally causes a skin rash, and the patch itself is cumbersome. Up to one third of individuals using a testosterone patch experience some discomfort.
Avoiding the inconvenience of a patch is Androgel which was approved by the FDA in 1999. Testim is another testosterone gel product. The gel is rubbed directly into the skin every day without the need for a patch. Many men find this the easiest and least irritating of the transdermal preparations of testosterone. Studies have shown high levels of patient satisfaction with gel product. In a study conducted at Duke University researchers found that men with testosterone levels less than 300 ng/dl treated with Androgel (testosterone gel) had significant improvement in sexual function, muscle strength and lean body mass. Overall satisfaction was better with Androgel than with the testosterone patch.
Can testosterone gel be of benefit to women too? Some physicians have used small amounts of testosterone gel applied to the clitoris and labia to improve sex drive and orgasm in women with sexual dysfunction. Controlled studies of testosterone gel used in this manner in women are currently not available although some experts assert that testosterone is beneficial to a woman�s sexual response.
There are several important precautions to follow when using testosterone supplementation. Although testosterone probably does not cause cancer to develop within the prostate, it will promote the growth of prostate cancers that otherwise may have been indolent. For this reason PSA levels should be monitored and the prostate examined regularly in testosterone users. Excessive amounts of testosterone may cause breast enlargement (gynecomastia) due to the body’s conversion of excess testosterone to estrogen. Aggressive behavior may be promoted as well.
Testosterone is a controlled substance which can be obtained by prescription from a licensed physician only. When used appropriately it can make a substantial contribution to the well being of men with hypogonadism.
I have been to see my Family Dr. due to the facts that I experience all of the symptoms of low testosterone. I had a physical and blood work performed. Do I need to go see a different Dr. to get a prescription? I believe the scale is between 1-5 and I am sitting about 1.5 to 2. Any suggestions?
Nathan
You did not say whether the results show low testosterone. If it did show testosterone was below normal some Family doctors would feel comfortable prescribing testosterone after trying to determine why the levels were low to begin with. Sometimes the family doc will refer a patient to a specialist such as an endocrinologist or urologist (specializing in disorder of the male reproductive and urinary tract).
Why don’t you ask your own doctor what was found and what the plan is for fixing it if the level is low?
Good luck
Gary Pepper, M.D.
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My testerone is at a level of 250. This is after 12 weeks of GH Injections. What are some of the products that can increase testerone, as GH is not doing the job. We are currently waiting for the last blood test to come back. I hear if I start using the patch, that I will have to use that for the rest of my life. Can you explain why that is? I am 38 years old.
Thanks
My urologist tested my testosterone levels and his assistance called me back and told me it was 47%. A measurement I do not see in all the articles. She said it said it was fine. I said this does not answer my question and complaint about all the symptoms I have indicating low testosterone. She told me he refused to discuss it and I should see my family physician.
How will a female internest be better to assit me than a urologist.
Who should I see. My PSA level is j2.9
So, the staement above, “In a study conducted at Duke University researchers found that men with testosterone levels less than 300 ng/dl treated with Androgel (testosterone gel) had significant improvement in sexual function, muscle strength and lean body mass,” does this mean that men using the patch will not have the same results as the gel? Is the gel more effective?
I am 40, testosterone just under 200, and just started on the patch, thinking it will be less of a hassle than the gel.
Gerry
For most people, it seems that the patch is more of a hassle than the gel. People report allergic reactions to the adhesive used to attach the patch to the skin. The gel should rub in and mostly disappear, although at higher doses a ‘greasy” residue may be left.
Everyone is different so you may prefer one type of application to the other. There is no reason you can’t get the same levels of testosterone with either method.
Be sure to ask your own doc if you have any more doubts.
Dear sir
can a male who has a low testrostone level now taking treatment for the past 1year
after the test in january the level of the Testosterone is increased can this defection can be rectified or not
Raja
My son is 19yrs. old and was diagnosed with hypogonadism about 2yrs. ago. His testosterone level was at 55 when the original lab work was done. He went through other test to rule out any other diseases, tumors, etc. He was on Androgel for about a year and a half…did well on it. Went to college and got lazy…he has since switched to injections but the process has been extremely slow since the doctor cut his dose in half to gradually work back up to 1cc in injection form. He is at 3/4cc and his last lab work was at 140. He has put on an extreme amount of weight…breast due to weight and is extremely frustrated. He is being treated by a local endocrynologist…but I am feeling like we should try to find a specialist in Hypogonadism. We live on the south east coast. Do you have a web-site, list, etc. where I might could find a specialist for my son?
At the age of 15, a non-cancerous tumor was found and removed from my right testicle . I went on to college, got a career, etc, but noticed that my rate of physical maturity was a lot slower than that of others my age. I’m now 31, and wanted to know if my testosterone levels could have been affected by my past illness at 15. I have my own health insurance now, and wanted to find the correct way to go about addressing this issue (if there is one).