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.

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  • nathan hayes

    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?

  • Dr. G. Pepper


    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.
    Terms of service for metabolism.com apply to this post

    • Alfonso

      Hello Gerry,

      Around Nov. 20, my blood test came back at 445. According to the M.D. I was seeing, it should be 800-1100. I was prescribed .2cc (20mg/mm) of testosterone cyp. twice a week. I radically changed my eating habits and began exercising. I’m 45 and as soon as I took the first dose I felt young. I used to feel nauseated after a workout, probably from low sugar level and even that went away. In less than a month I lowered my body fat from 26 to 13%. After that month, even though I have continued the prescribed dose, I’m feeling “old” again. I’m getting nauseated and tired. Is it possible that the original doses brought my testosterone levels back to normal and now my natural production has ceased to where now I’m back where I started? I’m going to get my blood checked again this week, but I’m just concerned of the sudden drop in energy.

  • Michael

    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.


  • Richard Stack

    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

  • Gerry

    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.

  • Dr. G. Pepper


    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.

  • raja

    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


  • Sheree Wright

    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?

  • Brian

    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).

  • Dennis

    At 55 I found myself suffering from fatigue, osteoporosis, hot flashes, and trouble with my memory. My doctor did blood tests which showed my testosterone to be at 42! Yes, that is correct, 42. He said it is the lowest he has ever seen. He has prescribed 1cc of Test. Cyp. every 2 weeks. After everything I have read this appears to be less than what I should be using. Even when I quetioned the Pharmacist he made a comment regarding the amount. I am 55 years old and weigh 220 lbs. What are your thoughts?

  • Scott

    I have been diagnosed with low testosterone. I also have peripheral neuropothy, and am taking the testosterone patches(androderm 5 mg).It seems that since taking this medicine, I have become irritable, argumentative and shot tempered. I still have a problem with getting an erection. I am becoming very frustrated both at home and work. Is there something else that can be done? I am at my wits end, I want to g et my testosterone level up, but it seems this method is not working. I am 5’9″ 272 pounds and a borderline diabetic, Please help[.

  • Kerry


    Just got my results today.
    Test free- 32.3 pg/mL
    testos bioavial— 65.1 ng/mL
    Test Total– 164 ng/mL

    49 year old Male and weigh 217 lbs
    I will see the endocr soon. I want to get on the testosterone treatments with Androgel. What questions should I ask and what can I expect?

  • i just found out though my V.A. Doctor that my testosterone levels (I’m 49yrs.Old) should be 220’s and mine is 70’s. I have osteoarthritis, fibromyalgia, numbness in upper legs, and lately my left nipple is very painful.I had a mammogram that came back ok thank God. So now the Dr. thinks that this is why i have Chronic fatigue syndrome. Will my energy come back to me after i start using the testosterone patches? I can’t hardly get out of bed for very long at all and i am hoping this will help me have a better life. Thank You All,and God Bless Each and Everyone, Dennis.

  • terry

    i,m 43 i have all symptoms of low t . i,m irritable, when i come home from work i,m spent. i have started to gain weight fast even though i work out and watch what i eat. depression and forgetfulness has started to creep in. every joint in my body hurts even though i have been threw every blood test out there (psa rheumatoid arthritis viruses even thyroid only thing found was low t.) my sex life is so so i have sex but its not as fulfilling and erections are not as hard as they should be and i,m loosing desire for my wife. my test results are 230 and 1.04 my Dr is leery of giving me t because in his words “its a very powerful drug and i,m just not sure about giving it to you”, so he is sending me to an endocrinologist witch will take almost 60 days to get an appointment. my question is: my dad and grandfather both had prostate cancer (both survived ) i get the psa regularly and mines fine should i worry about getting t replacement if they actually decide give it to me.

  • Dean Brown

    I’m 64 years old. Excellent health. 6 ft tall, 177 pounds, work out three times a week…….finding my self depressed, losing strength…..haven’t had any sexual desire in last 3 years……..I use the VA for all my health issues. My doctor said he tested my levels and they were normal, but he wouldn’t let see the results. Based on my info could someone tell me what my level should be at. Also, I noted someone said they got tested free…how is that ?? My only option without paying is to use the VA, and I’ve already noted that experience. Thank You.

  • jaafar

    I have been using tesosterone gel for the last six months , and i could not feel erection or mode improvment at all,iam very worried.

  • steve

    I began using the testerone patch 30 days ago based on blood work done by my Family Practice doc. My insurance didn’t pay for the patch. Family Practice doc refered me to a Urologist on Wed this week. Uro wrote scrip for gel. Insurance again didn’t pay and cost was offset about $30 with a cupon given to me by Urologist. The only thing BCBS pays for is the injection. Anyone out there have a solution? (other than change insurers)

  • This stuff really works wonders for a lot of guys, but the shots work way better than the gel IMO.

  • Amon

    I seem to gain about 5-8 lbs of weight in a week when I take androgel. For some reason this stuff makes me retain water or something. I KNOW my diet is impeccable and I exercise, mostly aerobic, not weight training, every day.
    I am wondering if anyone else has this problem, neither my family doctor or my endo seem to comprehend why this is. It is disheartening

  • Andrew

    I have been treated for ED for 5 years now with little success. At first it started slowly, then progressed to total dysfunction. Only rarely can I obtain an erection and NEVER can I maintain one sufficient for intercourse. My T was measured at 300mg/dl+/- and I was treated with Clomid, Testosterone, HCG, etc. and nothing has worked. PDE-5 inhibitors only give me “less than marginal” help. I can have an orgasm with a completely flaccid penis! 18 months ago, I failed an endothelial dysfunction test and went to a cardiologist who performed other tests and pronouned me(aggrevatingly) in good health. I’m at my wits and and so is my wife, who is divorcing me in July.

  • Dr. G. Pepper

    Hi Andrew

    I can’t tell you exactly why this is happening but there are two possible solutions I can think of; 1) Penile prosthesis which is a mechanical device which is inserted surgically. Some are simple rods which keep the penis erect at all times and others are more like pumps which can be activated when needed; 2)Penile injections. Medications like Caverject can be injected directly into the penis to cause erections.

    I recommend you consult with a urologist who specializes in these types of therapy to find out costs, complications etc.

    Good luck with this. This information is for educational purposes only.

  • John Burrows

    I’m so glad I found this site! About a month ago I was diagnosed with low T – mine is 140. Very, very low. Symptoms were NO libido, fatigue, massive weight gain (from 195 to 275 in 9 months), swelling below the knees. Not sure if the T is responsible for all of this, but would love your opinion (at the same time – the same day, actually – i was also told I had type 2 diabetes (blood sugar of 203). Is there a link here?

    My endocrinologist put me on Enenthate shots, 1ml every 2 weeks (done 2 shots so far). Do you think this is a good dosage? Are the shots better than the cream? I’m concerned about see-sawing T levels – will they go up after the shot but creep back down again before the next treatment?

    I’d really appreciate any insight, my doc did not spend a lot of time going into these kinds of details with me, it was a bit disappointing. I’m a white male, a little over 6′ and 42 years old. Naturally I understand you are only giving an opinion, not actual medical advice. Thanks so much.

  • Casey

    39 year old male, was physically active all my life. in 2008 discovered I had low Testosterone, Dr put me on Androgel. Was only one for 8 months. A massive blood clot from my gron to my ankle , my endocrinologist doesnt think the gel caused it. Over next two years ended up in ER two more times for blood clots while taking while taking 62.5 mg of warfarin. Turns out I have the factor iv clotting.
    I also have nacrolipsy, sleep apgnea, anxiety, depression, high blood pressure, blacking out, memory loss, unable to preform in any way. and the list goes on.

    The eight months on the androgel was honestly the best ive felt in my entire life.
    Are their any testostrone treatments that can help me out. I have researched it a lot, those with the factor five clotting, there have not been any cases claiming an increased risk of forming blood clots.

  • Paul

    in Canada the reference range for free testosterone is 25-80 pmol/L

    How do I convert this to the US range I find online? Thanks

    Also, it seems to vary a lot, do injections boost and drop your levels or does your body store amounts and maintain a steady amount? ie vs daily gel or patch.

  • LU

    My boyfriend is in his early 40’s and has been taking testosterone therapy. Instead of his levels increasing, they have decreased…his total is now in the single digits. He takes very good care of himself as he is a fitness trainer and body builder (takes vitamins, etc.). Obviously, with his total level being in the single digits, he has all the “symptoms” of low-T and is frustrated that the therapy is having a reverse reaction. He also suffers from Migraines and has recently been in a car accident that he suffered brain trauma in. I’m wondering if there could be a connection between the trauma and low-T or lower T. Any advice or direction you can head us in would be much appreciated.

    • Dr. G. Pepper

      Hi Lu

      You can’t pour water into a cup and wind up with less water in the cup then what you put in. Likewise, if someone takes testosterone supplement they will have more testosterone in their body then they started with. However, some things can influence the blood levels so one person will have higher or lower levels then someone else taking an identical dose. I have seen a wide variation in how testosterone gels are absorbed through the skin. These products include Androgel, Androderm, Testim, Axilron and Fortesa. One person may not see much of an increase in blood levels of testosterone on one of these gels while another will see levels zoom up to a 1000. Absorption of testosterone that is injected with a needle is less variable. Levels go very high in the first few days after the the injection but after 2 or 3 weeks levels will be low again. Here’s an important point. Since testosterone replacement turns off the body’s production of testosterone, if you stop taking replacement your body will not be making testosterone for weeks to months after resulting in very low levels on blood tests. People who abuse testosterone know this and will have the doctor check their testosterone level a month or two after their last dose, so the doctor will see the low levels and give them a prescription for more medication.

      Can head trauma effect the testosterone level? For that to occur the pituitary gland would have to be damaged and that will often be associated with other obvious brain damage. In children less severe trauma can hurt the pituitary.

      Hope some of this information is helpful in trying to figure out what is going on with your boyfriend. Good luck.

      Gary Pepper, Editor-in-Chief, Metabolism.com

  • Adam

    I’m 34 y/o and in generally good health. I began testosterone replacement three months ago. I was/am displaying all the symptoms of low T, which was confirmed when my test came back 317. Now I realize many men with low T have much Lower levels, however because of my symptoms the Doc started me on replacement therapy. So after three months of treatment I went back to be tested and my levels have dropped to 283. The doc told me to continue to take the same level for three more months and then retest. I wouldn’t be concerned if my levels had stayed the same or slightly higher, but the decrease is a concern. Should I seek a second opinion or wait it out for three more months.
    A little history…I had surgery for gynoclemastia when I was 12 years old…I had pretty developed breasts and I have always had a full chest. I assume there is a connection.
    Thanks for your help.

    • Dr. G. Pepper

      What sort of replacement are you getting? If you are receiving injections have your doctor check your testosterone levels a few days after your injection. I think you will find the levels are much higher than what you are seeing on your latest tests.

      Gary Pepper, M.D.
      Editor in Chief, metabolism.com

  • Adam

    Thank you for your quick response. I am using Androgel 1%, four pumps a day. I use it everyday as prescribed on my abdomen and shoulders. I opted for the gel because i was told it would help maintain my levels consistenly, more than the highs and lows of the injections.
    Thanks again for your feedback

  • Adam

    Thank you for your quick response. I am using Androgel 1%, four pumps a day. I use it everyday as prescribed on my abdomen and shoulders. I opted for the gel because i was told it would help maintain my levels consistenly, more than the highs and lows of the injections.
    Thanks again for your feedback
    Adam S.

  • Dr. G. Pepper

    Other testosterone gel preparations may be absorbed better. Even Androgel itself has been reformulated for better skin absorption. There is a wide variation between people in terms of how well the gels get into the blood. Perhaps your doctor will let you try another one of the gels to see if your testosterone levels respond better.

    If all else fails the intra muscular injections will work but I agree with you that the constant testosterone levels that are achieved with the gels are probably a better way to go.

    Comments for educational purpose only, not medical advise.

    Gary Pepper, M.D., Editor in Chief, Metabolism.com

  • Mike Pugh

    I to was having all the classic symptoms of low T. I went to my primary Doctor and had a blood test done. The results came back and I tested out at 255 on a scale of 249 to 849. I am 45 years old. My primary doctor would not prescribe anything for me since I was within the normal. I then went to an urologist who after looking at the blood work my primary Doctor performed prescribed 30mg of Axiron under each arm for me. After 6 weeks went back for follow up blood work. Results had dropped I was now 135 on a scale of 249 to 849. She doubled the dosage. After 4 weeks went back feeling worst than I did when I went the first time. I then went on shots 1cc every two weeks. I have taken my first shot yesterday, today seems a little better don’t know if that is psycological or not right now. But what should I see in gain on my blood work to know it is working properly when I do go back. If is not a signifigant gain what doseage should I discuss with her?

  • Marshall Odom

    I have been using a testosteron gel, 50mg per day. I recently I had testosterone salvia test done and the level was 24,676. How long will it take for the level to come down?
    Are there any side effects from a level this high?
    Certainly 50mg a day is too much. What dosage should I be using?

    • Dr. G. Pepper

      Hi Marshall

      I don’t know how accurate the saliva test is for measuring testosterone. Also the conventional unit of measurement is ng/dl. Is that what your 24,000 refers too or some different unit? Why not get a conventional blood test? Many testosterone gels are used in the strength you have used. My goal when treating low testosterone patients is to get the level above 400 but as always the patient’s sense of well being, strength, stamina etc is more important the the actual number. I don’t want to see the level over 1000 however as I regard that as excessive.

      Good luck with your treatment. My comments are for educational purposes only. Consult your own physician for actual treatment recommendations.

      Dr. Pepper

  • LU

    Dr. Pepper thank you for your response. As suspected something wasn’t right because as you said “You can’t pour water into a cup and wind up with less water in the cup then what you put in”. My boyfriend has been diagnosed with a pituitary tumor. Now to figure out the type of tumor and move forward, but this certainly makes things much clearer as to why the low T. Thank you again.

  • Marge

    Dr. Pepper, My husband had testicular cancer 10 years ago and has since been using both the shots for testosterone and more recently the gel. I have not been feeling well lately and had a saliva test performed. The results indicated my testosterone was well above normal (100+) My question is could the gel and shots my husband is taking effect me?

    • Dr. G. Pepper

      It is possible that you could be exposed to the testosterone gel being used by your husband. Once the testosterone is in his blood either because it is absorbed through the skin or because it was injected into a muscle you cannot get the testosterone into your body. Transmission of the testosterone in the gel to you can occur if the gel remains on his skin at the place where he applies it or on his hands and fingers. Make sure you follow the manufacturer’s instructions such as not to rub skin to skin for a few hours after he applies it and that he washes his hands with soap and water after applying the gel. The makers of Axiron a liquid testosterone applied under the arm, are promoting their product as being less likely to cause transmission of the testosterone to the partner because the application location (in the arm pit) isn’t conducive to skin to skin contact.

  • Dear Dr. Pepper,I have been taking testosterone for about 10 years,at first I too used the patches.The problem is I live in the south of Spain;going in and out of the pool was impossible and wearing trunks became difficult.I changed to the gel which we get on the national health system here.The problem is the old symptoms have returned,fatigue and tiredness and cramps in the legs and feet.Perhaps it is because I am now 64 and life is catching up with the cheating(testosterone).I have always sworn by the use of the gel,as only up until recently I felt as though I was always in my late forties.I have never had a break in the administration of the hormone,should I have one?Or do you think I will feel worse?I exercise at the local gym three times a week and eat a Mediterranean Diet I have no flab and I am told I look great.Have you any thoughts on why I should feel tired and should I take a break to start the motor in the body again? warmest regards

  • Sam

    Hi Dr. Pepper. I am 38 and generally healthy with what I believe an average testosterone level. I was wondering if that would be ok to use a short term testosterone patches for muscle development while doing workouts.
    Would that have benefits for muscle growth? Thanks.

    • Dr. G. Pepper


      I understand what you are trying to achieve and in theory I agree that taking short courses of testosterone will help you build muscle faster. But this is like taking diet pills to lose weight. As long as your taking the medicine the effect you strive for is achieved, e.g. weight loss or muscle development. What happens when you stop the medicine though? It’s likely you will return to the status you were in before starting the treatment. Only you can decide if the effort is worth it.

      Does that information help?

      Dr. G. Pepper

  • Michael

    Hello, similar to another person above, my GP had my “free testosterone” checked in November 2011 and it came back reading 35 pmol/L, and she said the range is 25-80. I can’t find an explanation for this range on the web, the vast majority of measurements are made in nmol/L or ng/dL. I’m 49, described to my GP that I am waking up 2-3 times a week with profuse sweating, disruptive sleep, which leads to a lack of focus on my work. I’m self employed so performance is important, because no one gives me sick days or benefits. With these symptoms, she wanted to prescribe sleeping pills and asked me to measure my temperature next time I wake up all sweaty, to rule out TB (there is no history in our family). Am I really within a ‘normal’ range? Many thanks for any insights, thank you.

    • Gary Pepper M.D.

      Hi Michael

      I’m not sure what is causing your symptoms but night sweats and disrupted sleeping could be many things including low testosterone but also stress, infections, thyroid disease etc. To answer your question about the units of measurement, free testosterone normal range in pmol/L is 25 to 80. I would describe your level as being in the low normal range. To help decide if this is normal for you, you can ask you GP to run the LH and FSH test. These are pituitary hormones that regulate the production of testosterone by your testicles so abnormalities of these hormones will indicate probable abnormality of testosterone production too. In my book Metabolism.com issues of testosterone deficiency and treatment are covered as well.

      Hope that helps..

      Dr. G. Pepper

  • Hussam

    Hi Dr. Pepper
    I experience all of the symptoms of low testosterone , my age is 30 and my free T level is 8.9 and the total T level is 455 so do i need any treatment for that


  • Julie

    My son was put on the androderm patch. He works irregular hours. Many times he works in the evenings. Is it better to put on the patch in the morning or at night?

  • John O.

    HI there; I got a call from the nurse from my doctor’s office this morning; She said the doctor would only be back in 10 days, but she gave me some numbers: Testosterone= 229; Sperm count= 5.6 mils (17% good). I know these cannot be good.
    I’d like to know how i can increase testosterone levels without affecting fertility, as my wife and I are trying to conceive? Most of what I’ve been reading as far as TRP seems to indicate that it might impede fertility.
    Thanks a lot!

  • Michael

    Hi. I am 44 years old, 6ft, and 240lbs. I’ve been having all the symptoms of low T….NO energy (sleep a lot), NO libido, infertility, feeling depressed or irritable sometimes, and belly fat…..so I went to my family doctor. He did bloodwork and I found out that my T level was only 6. The test was repeated a couple weeks later because my doctor thought an error had been made. This time it was 15….the lowest my doc had ever seen! Great. I also found out, at this same appointment, that I now have type 2 diabetes (glucose, 229), high blood pressure, high cholesterol (246), my AST (148) & ALT (237) are also high, and there’s something going on with my liver.
    My doc started me on Metformin (500mg 2/day) right away for the sugar problem, and then I started Testosterone Cypionate (1ml 1/week) injections about a week or so later. My wife has helped me greatly with changing my diet…..no more sugary, high sodium, or high fat foods, and more realistic portions. I don’t typically exercise because of my low energy and work schedule, but I have now started walking the treadmill a few days a week (20 min. mile).
    My question: at first, I felt like I was losing some of this weight, but all of a sudden it has seemed to come to a halt…..almost like I’m gaining instead of losing. (I’ve been faithful in following my diet plan) Could the T injections be causing this weight gain? It’s just hard to know the cause when I have so many other issues going on at the same time. Did the diabetes cause the low T?….or did the low T cause the diabetes? I feel like all I eat is sticks and twigs and am getting no results for my efforts. It’s very frustrating!
    Another thought: I was doing some research and came across Kleinfelter’s Syndrome. This fits me almost exactly…..as a toddler I learned to walk later than most, I was tall and lanky as a young boy, didn’t develop facial hair and muscular build like other teens, and had a lower energy level compared to other teens my age. I didn’t have any of the language development issues, but socially, I was kind of shy and stayed more to myself. I started developing breasts as a young adult, which is something that I am very self-conscious about. I have never been diagnosed with Kleinfelter’s Syndrome and haven’t mentioned it to my doc yet. Just wondering if a diagnosis as such would change my treatment plan. What are your thoughts?

    • Gary Pepper M.D.

      Hi Michael

      You have a lot going on. Did you doctor check your thyroid function? That could be helpful to know in trying to evaluate why you stopped losing weight. You are right however that the testosterone treatment may cause you to build muscle and therefore cause a slow down in your weight loss. But this would be a positive development because muscle will burn sugar and help control your diabetes and of course the muscle will make you look and feel better too.

      Your testosterone level is in the range of Kleinfelters which is among the most common mutation in men. The chromosomal pattern is XXY instead of XY. Breast enlargement (gynecomastia) is common. Have the doctor run an LH and FSH level because these should be high in Kleinfelter’s. After a few weeks on testosterone the LH and FSH levels may become normal or much lower than before Rx started so you should bear that in mind when looking at the results.

      The diagnosis of Kleinfelter’s is made on chromosomal analysis which you may want. It will tell you a lot about what is happening with you and whether you can have children.

      Keep us posted.


      Dr. P.

  • Mike

    I was having troble with fatique, weight gain, and borderline Type 2 diabetis. In addidtion I am suffering from ED which was of sudden onset. After lab work he informed me i had Low T. My doctor put me on androgel with not much success. He switched me to a 12 week injection protocol which I didn’t notice much change. After the 12 week therapy I received a call from his office that said me testosterone was within normal levels. He put me back on androgel as as a suppliment. I still see no improvement in my libido or ED issues. Should he be trying more than one type of Testosterone injection? Should I try applying the gel directly to my scrotum?


  • A Troubled Soul


    I am a 33, male, 5,11 having 170lbs weight. Right after my birth, my testis were not descended and I had a surgery when I was 12 but it was not successful and doctors were not able to find the testis and were of the view that the testis are destroyed somehow(i dont remember the details). I feel some small testis in scrotum but I never went for the physical exam after that.

    Long story short, my secondary sexual characters were not visible even at the age of 20(hair growth was too slow, low libido and very little erections). After running a lab test about Testosterones, FSH, LH and Androgens, T Level was at the lower border level and Progestrones and LH and FSH were high. I was told that its a primary failure by which they meant testis are not producing the hormones.

    I went for HRT 4 years back and had IV injections for about one year. Therapy changed me a bit and muscle growth, voice change, frequent erections etc. were visible. After that I stopped the therapy and now I have gained weight specially in feminine areas (hips, chest etc.). I feel fatigued, sleep a lot, get tired easily, tend to forget things and no erections unless I specifically put something in my mind(if you know what i mean :)). I had a complete medical check-up last year and the doctor asked me to go for the lab tests about Testosterones and FSH etc.

    My question is about the side effects of HRT related to T and how it could effect my liver or any other organ specially kidneys as my one kidney was found to be smaller than the other one. Secondly whatt is with the weight I have put on around the hips area and specially on my chest as its embarassing and making me not to wear t-shirts. I believe I have to get those tests run again and then go for some therapy again but I am worried about side effects. Your kind advice would be highly appreciated.

    A troubled soul.