Testosterone Replacement

Understanding Low T

Testosterone is produced in the testicles and stimulated by leutinizing hormone which is produced by the pituitary gland.
In some men the amount of testosterone produced decreases as they age at a faster rate than other men.
Symptoms of low T are lack of sex drive, decreased energy, decreasing muscle mass, sleep disorders and sexual dysfunction.
Oral replacement of testosterone is not as effective as topical or I.M. therapy.
There are many forms of replacement therapy to include topical gels or creams, I.M., subcutaneous pellets and buccal patches.
The type of therapy best for the patient is often times a matter of preference in terms of the nature of the gel or cream of a particular product, the location where it applied, the frequency required, and which is best covered by insurance.
There are brand name products and many compounding pharmacies offer testosterone replacement products.
Testosterone is a diurnal hormone meaning that it is lower or higher at certain times of the day. This characteristic as well as the fact that the normal range is very broad (380-1100)makes the diagnosis and treatment more difficult.
Testosterone Replacement Therapy (TRT) is safe but there are potential side effects and therapy must be monitored with periodic blood work.

Testosterone Replacement Products

I.M.-Testosterone Cypionate and other forms of I.M. testosterone are given usually twice a month. The advantage of therapy is that a patient can have it given at a doctor’s office or do the injection at home. The cost is sometimes better compared to other products. The disadvantage is it has a peak level at 5-7 days and then slowly diminishes until the next shot. Because of this there is an up and down nature to the levels of testosterone. Most urologist feel it is better to have a steady level as the up and down levels can cause mood swings.
I.M.-Aveed is similar to Testosterone Cypionate but has a much longer period of action. A 3ml injection of Aveed lasts approximately ten weeks. It has a set of potential side effects that must be taken into consideration by the patient.
Topical-Topical therapy is probably the most common form of replacement testosterone. The gels vary in their characteristics and in the area of the body to which it is applied. Brand names include: Androgel, Fortesta, and Axiron.
Subcutaneous-Pellets can be placed in the fatty tissue of the buttocks. The advantage of this therapy is the duration of action. Most pellets last between 3-4 months. Testopel is an example of this form of therapy.

Urology Care Foundation-Update on Testosterone Replacement Therapy

What to Expect at an Office Consultation Regarding TRT.

The most common reason a patient presents to a urologist’s office is a low testosterone value which has been obtained by the family doctor.
The most common complaint is that of lack of energy and diminished sex drive.
The urologist will perform an exam of the testicles and prostate and review the values. The testosterone might very will be repeated to sure it is done in early morning and testing for LH and FSH is usually added.
If the symptoms are consistent with Low T and the testosterone value is low then replacement therapy is considered.
A discussion of potential risk factors of TRT ensues.
Once all of the “bases have been touched” the male is given a trial of testosterone and followed at a month to see if there has been any improvement in the symptoms and possibly to repeat the T value to assess its progress.
The dose of the trial can be adjusted up or down depending on the response and values. As well, a different product can be used. For instance, changing from an inner thigh application of Fortesta to an underarm application such as Axiron.
Once the testosterone is regulated, type of TRT agreed upon then the patient is followed on a 4-6 month basis to be sure the levels of testosterone are stable, and that no effect of the medicine on the blood count or the liver enzymes has occurred.
Surprisingly the product chosen often times depends on what the patient’s insurance will pay for. Sometimes the physician-patient visit revolves around finding a drug that works and that the patient can afford.
Patients that do well on TRT do very well. They are usually very enthusiastic about the treatment and report better sleep, energy, sex life and better mood. Some patients see no difference in therapy and abandon it.
Some experts in the field of TRT sum it up this way, “If you need it you’ll feel better, if you don’t need it you won’t.”