Low testosterone (Low T) can lead to a number of symptoms. These include erectile dysfunction, decreased sex drive, loss of body hair, decreased energy, increase in body fat, decreased bone strength and muscle mass. These symptoms can also come from other medical problems, medications and habits such as smoking or drinking too much alcohol.
Low T can be caused by a variety of medical problems, but is mostly associated with normal aging. Chronic use of pain medications and pituitary gland problems are common causes.
The evaluation for low testosterone will include a history and physical exam and lab testing for testosterone. The lab test is generally done twice, and usually in the morning to get the best results. In patients who have very low testosterone, or who also have infertility problems other testing may be recommended.
The treatment for low testosterone is based on replacing testosterone. T can be replaced via gels, creams, injections or testosterone pellets. Each of these modalities has different advantages and limitations. Injections are usually done every 7-14 days, and tend to be less expensive, but create a peak and valley affect where patients can be bothered by feeling “low“ prior to their next injection. Gels and creams give a steady state, but have to be applied every day, and can be transferred to spouses and children. They also tend to be very expensive. Testosterone pellets have the advantage of maintaining levels over many months with one application, and usually avoid the peak and valley affect. Because they are given in the office, the patient’s cost is usually far less than with the gels.
Recently, there has been some controversy about testosterone replacement therapy. There are some research papers that indicate a higher risk of cardiovascular risk such as stroke and heart attack in patients who use testosterone supplementation. Other researchers do not believe that there is a risk. Patients who are considering T replacement need to be aware of this controversy so that they can make an informed decision. The FDA is currently investigating testosterone replacement to confirm that it is safe, and to give clinical guidelines for doctors and patients.
If you have any questions, or would like to schedule an appointment for low testosterone treatment, contact Urology Specialists of Oregon at (541) 322-5753.