Low T &
TRT Resources

Testosterone is a hormone found in humanas, as well as in other animals. In men, the testicles primarily make testosterone. Women’s ovaries also make testosterone, though in much smaller amounts.

The production of testosterone starts to increase significantly during puberty and begins to dip after age 30 or so.

Testosterone is most often associated with sex drive and plays a vital role in sperm production. It also affects bone and muscle mass, the way men store fat in the body, and even red blood cell production.

Low levels of testosterone, also called Low T, can produce a variety of symptoms in men, including:

• Decreased sex drive
  

• Less energy
  

• Weight Gain
  

• Feelings of depression
  

• Moodiness
  

• Low self-esteem
  

• Less body hair
  

• Thinner Bones
  

While testosterone production naturally tapers off as a man ages, other factors can cause hormone levels to drop.

Usually, your doctor or HCP will order a total testosterone blood test first. This test provides one measurement of all the testosterone in your blood sample, which includes free testosterone plus testosterone that's attached to proteins. But this test doesn't show how much of your testosterone is free for your body to use. So, you could have symptoms from too little or too much free testosterone even when your total testosterone level is normal.

If your total testosterone level doesn't explain your symptoms, your provider may order a sex hormone binding globulin (SHBG) blood test to help learn how much free testosterone you have. SHBG and total testosterone tests may also be done at the same time.

The SHBG test measures the level of three sex hormones found in both males and females: estrogen, dihydrotestosterone (DHT), and testosterone. SHBG carries these 3 hormones throughout your blood. However, the hormone that's critical in this test is testosterone. SHBG controls the amount of testosterone that your body tissues can use. Too little testosterone in males and too much testosterone in females can cause problems. The level of SHBG in your blood changes because of factors such as sex and age. It can also change because of obesity, liver disease, and hyperthyroidism.

If your doctor or HCP determines that you have Low T (through a combination of symptoms and testosterone blood values below the lower limit of normal) they will recommend treating it with one of the following options:

• Oral capsules
  

• Injections
  

• Gels
  

• Patches
  

• Surgically implanted pellets
  

The benefits of testosterone replacement therapy vary based upon the pre-therapy symptoms and other factors, but they can include the following:

• Increased Energy
  

• Decreased irritability and depression
  

• Improved muscle mass and strength
  

• Improved sexual desire
  

• Improved cognitive function and verbal memory
  

• Higher motivation
  

• Decreased body fat (optimal results received through accompaniment of a diligent diet and exercise regimen)
  

• Possible improvement in erectile function
  

• Thicker skin
  

Some patients could experience one or more of the following side effects from testosterone replacement therapy:

• Increase in red blood cells. This can be beneficial if you have anemia. However, it can be potentially dangerous because an increase in red blood cells can lead to blood clots, heart attack, or stroke.
  

• Prostate effects. If you have an enlarged prostate, testosterone may worsen your symptoms, particularly if you are more than 50 years of age. If you have a history of prostate cancer, you cannot receive testosterone therapy without prior clearance from the urologist who is overseeing your care.
  

• Skin reactions. Acne, oily skin, increased body hair, and flushing have been reported. These side effects are not very common, but if they occur, often they are transient.
  

• Infertility. Testosterone therapy down regulates production of a man’s sperm. Be upfront with your medical provider about your desire for children and be sure to discuss the situation with your spouse or partner, if appropriate.
  

• Sleep apnea. This is a condition that disrupts breathing during sleep, and if already present, may be worsened by the use of testosterone therapy. If you snore or suspect you may have sleep apnea, be sure to talk to your medical provider about the situation. Considering a sleep study for further evaluation may be appropriate prior to starting therapy.
  

• Fluid retention. Although uncommon, you must use caution if you have a history of heart failure or kidney disease.
  

Only your physician can fully answer this question; however, in general, testosterone replacement therapy is not recommended for, or should be avoided by, patients with the following conditions:

• Breast or prostate cancer
  

• A palpable prostate nodule
  

• Erythrocytosis (when a person has a higher concentration of red blood cells in their blood)
  

• Hyperviscosity (a syndrome when person’s blood thickens so much that it doesn't flow freely through blood vessels)
  

• Severe benign prostatic hyperplasia symptoms (AUA prostate symptom score > 19)
  

• Uncontrolled severe heart failure
  

• Unexplained PSA elevation
  

• Severe lower urinary tract symptoms associated with benign prostatic hypertrophy
  

• Unstable severe congestive heart failure (class III or IV)
  

Below is a description of each type of testosterone replacement therapy treatment option.

• Oral: The FDA has recently approved oral testosterone (testosterone undecanoate). All three options are a safe, convenient and effective method to raise serum testosterone levels in men with Low T. Enhancements and modifications to the oral testosterone capsule delivery system have allowed the medication to improve serum testosterone levels and bypass liver metabolism, without causing liver toxicity, which is an improvement from previous, older iterations of oral testosterone (Methyltestosterone) which had liver-related side-effects. These newer treatment options are able to sustain serum testosterone concentrations between 300 -1000 ng/dL.
  

• Injections: Testosterone injections can be administered by your doctor or HCP or done at home using a home injection kit. They are typically given weekly, though it is important to follow your doctor’s prescribing instructions. The needle for injection is small, and typically, the medication is injected just under the skin. If the injection site is not sterilized prior to injection, there is a risk of infection, redness or swelling. An expected potential side effect of injection therapy is an increased level of red blood cells. This “side effect” can be a desired therapeutic effect in men with anemia.
  

• Pellets: Testosterone pellets are small crystals that are implanted near your hip in a short, simple procedure in your doctor’s office. Testosterone pellets are implanted and last generally three to six months. The ease of use makes testosterone pellets a good option for some men.
  
  The pellets must be implanted in your doctor’s office, and since the pellets are injected, the dosage cannot easily be adjusted. In addition, implanting testosterone pellets causes a break in the skin, so there is the risk of infection or scarring.
  

• Gels: Testosterone gels are usually applied once daily in the morning to clean, dry skin. Testosterone gels are directly absorbed through the skin. Where the gel is applied depends on the brand. Some are applied to the upper arm or shoulder and others are applied to the thigh. It is important to cover the application site as soon as the gel has dried to prevent accidental transfer. Side effects specific to testosterone gels include watery eyes, headaches, dry or itchy skin, diarrhea and skin redness or irritation.
  

• Patches: A skin patch applied once a day is worn on the arm or upper body and delivers a dose of testosterone. Testosterone patches tend to be easier to apply than testosterone gels and decrease the risk of accidental transfer of testosterone to women or children. Testosterone patches should not be applied to oily or hairy skin, areas of increased perspiration, over a bone, or places where pressure is applied when sitting or lying down. You need to choose a different spot each night for the application, and the same spot cannot be reused for a minimum of seven days. There are also mouth patches that stick to the upper gums. They are applied twice a day, and continuously release testosterone into the blood through oral tissues in the mouth.Side effects from testosterone patches may include burn-like blisters, redness, pain, or itching at the application site