As we are bombarded by TV commercials touting the benefits of testosterone replacement for men, it would appear that these medications transform men into an idyllic world of muscles, boats and women.
What is Low T?
The term Low T Syndrome refers to the aging process, although often many factors are involved. The rate at which testosterone declines varies greatly among men. As many as 30 percent of men older than 75 have a testosterone level that’s below normal. The diagnosis of Low T Syndrome requires the presence of symptoms as well as low testosterone levels.
Do You Have Symptoms?
Take this ADAM (Androgen Deficiency in the Aging Male) questionnaire:
- Do you have a decrease in libido (sex drive)?
- Do you have a lack of energy?
- Do you have a decrease in strength and/or endurance?
- Have you lost height?
- Have you noticed a decreased “enjoyment of life”
- Are you sad and/or grumpy?
- Are your erections less strong?
- Have you noticed a recent deterioration in your ability to play sports?
- Are you falling asleep after dinner?
- Has there been a recent deterioration in your work performance?
If you answered Yes to number 1 or 7,or, if you answer Yes to more than 3 questions, you may have low testosterone.
There are many causes of low testosterone (hypogonadism) some genetic syndromes, undescended or trauma to testicles, mumps, cancer treatment, pituitary (the brain’s hormone control center), inflammatory diseases, HIV/AIDS, medications (especially narcotics), obesity, diabetes, sleep apnea and normal aging.
Get Evaluated from a Medical Provider
Of course, these symptoms are very common for men of all ages and may mimic many different medical problems. You need to have a complete evaluation with your medical provider before considering testosterone replacement. This evaluation will include a thorough medical history, physical and lab work including: testosterone (measured in the morning), PSA, and evaluation of cardiovascular risk. These evaluations include BMI (body mass index), identifying metabolic problems such as diabetes and elevated lipids. Some men may need other hormone tests, a bone density test, a sleep or other studies.
Testosterone is contraindicated in men with prostate and breast cancer. The blood test PSA (prostatic specific antigen)and digital rectal exam are necessary before starting and continuing with treatment. Also, men with family history of prostate cancer may be at increased risk for testosterone.
What’s a Good Number?
There are no absolute cut off for testosterone levels, there is a large range of normal. If you have many of the symptoms above and a serum level less than 200mg per dL you may have Low Testosterone Syndrome.
Healthy Ways to Increase Testosterone Levels – Without Medication
These suggestions should be discussed with your medical provider to see what would work for you. As you can see there are many risks to low testosterone and poor health in general, so weight loss and exercise are crucial to good health,
- Lose Weight: If you’re overweight, shedding the excess pounds may increase your testosterone levels, according to research presented at the Endocrine Society’s 2012 meeting. Overweight men are more likely to have low testosterone levels to begin with, so this is an important trick to increase your body’s testosterone production when you need it most.
- High-Intensity Exercise like Peak Fitness: Short intense exercise has a proven positive effect on increasing testosterone levels and preventing its decline. That’s unlike aerobics or prolonged moderate exercise, which have shown to have negative or no effect on testosterone levels
- Strength Training: In addition to Peak Fitness, strength training is also known to boost testosterone levels, provided you are doing so intensely enough. When strength training to boost testosterone, you’ll want to increase the weight and lower your number of reps, and then focus on exercises that work a large number of muscles, such as dead lifts or squats.
- Optimize Your Vitamin D Levels: Vitamin D increases levels of testosterone. Overweight men who were given vitamin D supplements had a significant increase in testosterone levels after one year.(1)
- Reduce Stress: When you’re under a lot of stress, your body releases high levels of the stress hormone cortisol. This hormone actually blocks the effects of testosterone.
- Eliminate Narcotics: Chronic pain reduces testosterone as does opioid narcotic medication.
- Sleep Apnea: Sleep apnea, which is often related to obesity, can lower testosterone and needs to be treated often with weight loss and CPAP.
Types of Testosterone Replacement Therapy
Testosterone replacement can improve a man’s energy, libido (sex drive), muscle mass, sleep, energy level, and depressed mood. Testosterone replacement has been shown to also decrease body fat in men. Testosterone supplementation for men with bone thinning ( osteoporosis) can reduce fracture rate. Several testosterone delivery methods exist. Choosing a specific therapy depends on your preference of a particular delivery system, the side effects and the cost. Methods include:
- Injection: Testosterone injections are safe and effective. Injections are given in a muscle about every two weeks. Your symptoms may come and go between doses. You or a family member can learn to give TRT injections at home. If you’re uncomfortable giving yourself injections, a nurse or doctor can give the injections.
- Patch: A patch containing testosterone (Androderm) is applied each night to your back, abdomen, upper arm or thigh. The site of the application is rotated to maintain seven-day intervals between applications to the same site, to lessen skin reactions.
- Gel: There are several gel preparations available with different ways of applying them. Depending on the brand, you either rub testosterone gel into your skin on your upper arm or shoulder (AndroGel, Testim), apply with an applicator under each armpit (Axiron) or, spray on your inner thigh (Foresta). As the gel dries, your body absorbs testosterone through your skin. Gel application of testosterone replacement therapy appears to cause fewer skin reactions than patches do. Don’t shower or bathe for several hours after a gel application, to be sure it gets absorbed. A potential side effect of the gel is the possibility of transferring the medication to your partner. You can avoid this by avoiding skin-to-skin contact until the gel is completely dry or by covering the area after an application. All preparations contain testosterone, the same hormone your body normally makes.
- Gum and cheek (Buccal Cavity): A small putty-like substance, gum and cheek testosterone replacement (Striant), delivers testosterone through the natural depression above your top teeth where your gum meets your upper lip (buccal cavity). This product quickly sticks to your gumline and, as it is exposed to saliva, softens into a gel-like form, allowing testosterone to be absorbed into your bloodstream.
- Implantable Pellets: Testosterone containing pellets (Testopel) are surgically implanted under the skin and need to be placed every three to six months.
- Oral: Taking testosterone orally isn’t recommended for long-term hormone replacement because it may cause liver problems, raise your cholesterol and increase your risk of heart disease.
Sales of herbal testosterone “supplements” or “stimulants” have skyrocketed as men attempt to regain their youth using these “all-natural” products. These products have not been studied for efficacy or safety and should not be used.
After treatment is started, lab testosterone levels can be drawn, however, the goal is not to treat a lab test but to manage symptoms, so frequent followup wwith your provider is important. Some of our patients who start on testosterone supplementation and can discontinue when they change their lifestyle with weight loss and exercise. Some men do not feel any improvement with supplementation, so it is discontinued.
Side Effects of Testosterone Replacement Therapy
- Enlarged breasts
- Symptoms of enlarged prostate
- Increased red blood cell counts
- Worsening COPD
- Leg edema
- Liver function abnormalities.
In January, the FDA issued a safety announcement that they are evaluating risk of stroke, heart attack and death with FDA-approved testosterone products. The FDA is studying testosterone supplementation safety after 2 recent studies that suggested an increase risk of cardiovascular events in mean taking supplementation.
The issue of testosterone supplementation remains controversial. If you have symptoms or concerns please see your provider to see what options will be the best for you.
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