Let's talk about low testosterone...

Testosterone is a steroid that is produced by the body and is found in almost every animal and virtually every vertebrate. In mammals, testosterone is produced primary by the testicles and a small amount by the ovaries in the female.  There is also a small and residual amount secreted by the adrenal glands.  It is the primary male sex hormone and it is also an anabolic steroid.  In men, testosterone plays a key role in sexual function and reproductive function.  Tissues as the testicles and the prostate, as well as secondary sexual characteristics, are all induced by testosterone.  It also causes an increase in muscle mass, bone mass and growth of the body.  In addition, testosterone is very important for general wellbeing and the prevention of bone thinning. 

With age, it is normal that a great number of humans will notice a degree of decline in their testosterone levels.  The range of that decrease is extremely variable, but there are a lot of men that even past their 40’s will notice a very significant decrease in their testosterone.  There is great discussion among different specialists regarding the replacement of testosterone.  The position of the American Society of Andrology is that testosterone replacement therapy in aging men is indicated when clinical symptoms and signs of low testosterone are present.  We will review those signs below.  Previously age related decreases of testosterone were simply accepted as normal, whereas now we consider them a possible point of intervention when a patient is suffering from the obvious symptom. 

The symptoms of low testosterone could include low energy levels, low libido or sex drive, changes in mental process, difficulty losing weight, easy loss of muscle mass, erectile dysfunction and a precursor for the development of diabetes and cardiovascular disease. 

All of this can be very simply diagnosed with a blood test to determine the levels of free and total testosterone.  Once you are diagnosed to have a low testosterone level, the replacement can be completed in a number of different fashions. 

The more common form of testosterone replacement is by injection using intramuscular doses that are adjusted for the patient in particular. 

In the recent years, we have migrated to more and more use of topical gels that can be bought commercially or prepared by compounding pharmacies in order to achieve maximum enhancement of your testosterone.  These are usually gels that are applied on a daily basis.  Another less common way of applying your testosterone is by using subcutaneous pellets which are installed under the skin in your doctor’s office every three to four months.  Whatever the method of your choice, it is important that your testosterone levels are checked at intervals to make sure that you are reaching the necessary and appropriate level. 

In spite of all the fear mongering in the medical community, testosterone is truly a safe therapy.  It is not true that it will significantly increase your chances of cardiovascular or liver disease and it is absolutely untrue that it will increase the rate of liver or brain tumors. 

There are two things that are important to be aware of when one replaces testosterone.  When you get testosterone from outside the body, your testicles interpret that you are getting the testosterone from somewhere else and they can begin to shrink.  In a small number of patients there is a noticeable decrease in the testicular size.  There is also a significant decrease in sperm cell production.  Even so, this can be offset by using an injection of something called beta-HCG on specific cycles depending on the particular patient.  We can also offset these events by using an oral medication called Clomid. 

The management of testosterone therapy is more complex than we can discuss on a blog site, but the above information should be sufficient to get you started.  A heart to heart discussion with your urologist is of utmost importance in deciding if you are a candidate for testosterone replacement, and with what method.  Patients with true decreases of testosterone levels have a remarkable and happy result in a short period of time with significant increases of energy, muscle mass, libido and sexual function.  It is a simple thing to diagnose and treat and there is no reason not to seek advice.  We are more than happy to answer your questions in our office or you can start by asking your primary care physician. 

Raul Hernandez, MD Raul A. Hernandez, MD President, Fog City Urology - President, Golden Gate Urology

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