Testosterone is a predominantly male hormone that supports normal sex drive, bone and muscle mass, red blood cell production, and mental health. While testosterone levels gradually decline with age, many men do not notice a change in health and vitality despite lower levels of testosterone. Some men do, however, experience bothersome symptoms related to this a decline. Testosterone replacement therapy (TRT) may benefit men who suffer from low testosterone.
What is low T or hypogonadism?
A great deal of interest has been given to the disorder of low testosterone (low T) or hypogonadism in the last few years. The issue has garned some controversy as various men’s health clinics and sexual health clinics offer TRT to all men, promising enhanced sexual and physical vitality. In these clinics, TRT is positioned as the “Fountain of Youth” for men as they age. Truly, however, testosterone does decline naturally with age and many men maintain health despite lower levels of testosterone. For men that appear to have symptoms that may be related to low T, laboratory assessment can be pursued. Testosterone levels are assessed in an early morning lab draw and confirmed with a second lab draw. Further testing may be necessary to assess etiology of low T levels.
Who should consider TRT?
While not all men with low testosterone (low T) will benefit from testosterone replacement therapy (TRT), we may consider checking testosterone levels in men with mood changes, decreased muscle mass, fatigue, increased body fat, and diminished libido (interest in sex). Some men with low T may also suffer from anemia, decreased bone density, hot flashes, impaired cognition, and breast growth.
Lifestyle changes alone can significantly improve sexual function, energy, mood, and muscle mass for most men.
For patients that struggle with lifestyle modifications or desire a trial of testosterone therapy, TRT has been shown to improve libido, anemia, bone weakness, lean body mass, and depressive symptoms. The American Urological Association and Endocrine Society guidelines affirm that a trial of TRT could be considered for men with evidence of low T and confirmed low testosterone lab values.
Does TRT cure erectile dysfunction?
Unfortunately, testosterone is overutilized by some men’s health clinics for the treatment of erectile dysfunction (ED). Evidence suggests that TRT does not improve erectile function for the majority of men and is not an appropriate first-line treatment for ED. Dr. Thompson has treated many patients with bothersome Erectile Dysfunction and is able to offer many successful therapies. Although TRT does not cure ED, some men with low T and ED may experience an improved response to their oral ED medications.
How is TRT prescribed?
Testosterone supplementation can be prescribed as gels, injections, or implanted pellets. While the FDA approved a pill formulation in 2019, it is typically reserved for younger men with specific medical conditions. We offer appropriate patients a 3-6 month trial of TRT to assess benefit and evaluate for any possible risks. As men gain motivation and energy needed to pursue lifestyle modifications, many men eventually stop TRT. Risks of TRT may include increased red blood cells, rising PSA, and exacerbation of sleep apnea or urinary symptoms. For men who pursue a course of TRT, routine lab monitoring is essential.