Low T: What all men need to know

Testosterone deficiency, also known as hypogonadism, affects approximately 4 out of 10 men over the age of 45. It’s a common condition that’s often brought on by chronic medical conditions, such as high blood pressure, diabetes, infections (including HIV/AIDs), obesity, liver or kidney disease, as well as the aging process. The physicians at Erlanger Health System offer simple, effective treatment options that can help.

Testosterone is a hormone produced mainly in the testicles that encourages sperm production, stimulates sex drive, and helps to build muscle and bone mass. Around age 30, testosterone production starts to decrease about one percent each year. A decrease in testosterone levels is a normal part of aging.  However, sexual health and lifestyle may be impacted if testosterone levels drop too low.

Symptoms
Talk to your doctor about the potential for testosterone deficiency if you experience any of the following symptoms:

• Low sex drive, or decreased libido
• Difficulty obtaining/maintaining an erection
• Increased fatigue, irritability, mood changes, and depression
• Insomnia or other sleep disorders, like sleep apnea
• Weakness
• Increased body fat and loss of muscle mass

To assess the presence of a testosterone deficiency, your doctor will ask questions about your symptoms, perform a physical exam, and administer a blood test to check your current total and free testosterone levels. It is important, however, that you exhibit symptoms of low testosterone prior to getting your testosterone test. Some additional tests may also be needed to rule out other hormone irregularities that can identify other serious medical issues. Sometimes, these serious issues can lead to symptoms that mimic low T symptoms — and not identifying them may be detrimental to your overall health, e.g., sleep apnea, diabetes mellitus, and brain tumors.

Treatment
Once the symptoms of low T are identified and confirmed by evaluation and testing, it’s time to discuss treatment options. Injections, patches, topical creams/gels, and implanted pellets are all available options for replacing testosterone. Your symptoms of low T and goals for treatment will determine the type of therapy that is appropriate for you.

Topical gels and creams are applied onto the skin daily.  Topical treatments can sometimes lead to rashes and irritation. Because they are applied directly to the skin, it is possible to spread the treatment to a partner, child, or pet upon contact. Caution should be taken to avoid this type of contact as it can cause side effects in others.

If daily applications of a topical ointment aren’t in your plans, you may opt for injections. Injections can be administered by a medical professional or self-injected. They last anywhere from four to seven days and up to three months, depending on the type of injection chosen. Though effective, there is concern that the hormone spikes and drops caused by injections could affect some men’s mood, stability, and sexual activity. It’s important to notify your doctor if you notice these types of changes during treatment.

Pellet implantation is another option and can be performed as a quick in-office procedure using a local anesthetic. The small implants slowly release testosterone over the course of three to six months. And because the hormones are on a delayed release, pellets don’t cause the spikes that injections sometimes can.

Testosterone therapy should not be used for any non-medical reason, such as bodybuilding or performance enhancement, and should not be used if you are trying to father a child — as it can severely decrease your sperm count. Additionally, it is important to understand that just because a man has low testosterone does not mean he needs testosterone replacement therapy to function normally. Only those men who have the symptoms of testosterone deficiency should undergo testosterone replacement therapy. This would expose an individual to side effects rather than benefiting from treatment. Before beginning any hormone therapy, be sure to talk to your doctor about possible side effects. These can include:

• Acne
• Enlargement of breasts
• Swelling of the feet or ankles
• Smaller testicles
• Infertility

Men with untreated sleep apnea, untreated severe congestive heart failure, liver disease, or a history of blood clots should not undergo testosterone replacement therapy. Men with preexisting heart disease should proceed with caution when considering testosterone replacement.

Dr. Anand Shridharani, urologist with Academic Urologists at Erlanger, specializes in men’s reproductive and sexual health. For more information, or to make an appointment, please call 423-778-2564.