Low testosterone is a hormonal issue in which you become deficient in testosterone. According to the American Urology Association, every 2 men out of 100 have this problem. Low testosterone is more common in older men compared to younger ones. Studies also indicate that 40% of men aged at least 45 have low testosterone or testosterone deficiency. Here are the frequently asked questions related to low testosterone treatment that will help you understand it better.
What roles does testosterone play in my body?
Testosterone is the main male sex hormone, but it is also produced in females in minute quantity. In men, it is produced by testicles when they receive messages from the pituitary gland, which is located underneath the brain.
It is responsible for several functions in a man. Some of its roles are:
- Maturation of testicles and penis during adolescence
- An increase in sexual desire, also called libido
- Production of sperms
- Development of hair on body and face
- Increase in the muscle mass and bone density
- Encourage the production of red blood cells
- Effect fat metabolism and distribution
- Effect mental health and heart health
What is the normal level of testosterone in blood?
Levels of testosterone in blood change in men throughout their lives. They are at their peak during adolescence and early adulthood. Then they start to decline with every passing year. Testosterone levels also vary throughout the day. It is believed they are highest in the morning and then start decreasing and reach their lowest in the afternoon. The normal testosterone levels in healthy adult men range from 300 ng/dL to 1000 ng/dL.  If your testosterone level is below 300 ng/dL, you may have low testosterone (abbreviated as low T). It is also called testosterone deficiency syndrome (TD).
What are the common low T symptoms?
Low T symptoms vary from individual to individual, and they are often subtle. Below is the list of the common signs that men with low T may experience.
- A decline in sexual desire
- The problem in achieving and maintaining an erection
- Decrease in the production of semen
- Low energy levels and fatigue
- Loss of body and facial hair
- Weight gain and increase in body fat
- Increase in breast tissue
- Loss of muscle mass
- Low bone mass density
- Irritability, depression, and mood swings
- Decrease in the production of red blood cells
- Reduction in testicle size
How is low T diagnosed?
Low T signs are often subtle, due to which they are not sufficient to identify the issue. If you think you have low T, your doctor will test your testosterone levels through a blood test. Sample for the low T-test is usually taken in the morning when the levels of testosterone are high. Your doctor may ask you to retake the test to further confirm low T levels. Certain medications can decrease your testosterone levels temporarily. If you are taking any medication, it is best to inform your doctor before having your testosterone levels tested.
Is low T a part of ageing?
Many changes occur to the body as you move towards old age. One of these changes in men is the low production of low testosterone. Data and research indicate that around a 1% decline in the T level occurs each year after a man crosses 30. In some men, this decline in T levels is not very prominent, while in others, it is very distinguished. Your health and lifestyle may also have an impact on the T levels.
What else can cause low T?
Not all men experience low T during old age. Some can develop this issue even during their 20s. There are multiple other reasons behind the decline in T levels. Some of these reasons are:
- Trauma of testes
- Excessive iron in the body
- Cancer treatment
- Certain medications such as opioids
- Dysfunction of the pituitary gland
- Liver disease or kidney failure
- Drinking alcohol excessively
- Type 2 diabetes
- Extreme changes in the weight; either excessive weight loss or weight gain
- Excessive production of estrogen
- Brain surgery
- Sleep disorders such as obstructive sleep apnea
Can I regain my normal testosterone levels?
Yes, you can. There are different methods of doing that. If you have low T, the first thing your doctor will tell you is to bring changes to your lifestyle and try natural ways of increasing testosterone levels. Some of these ways are:
- Eat a balanced diet consisting of all the macromolecules like carbs, proteins, and fats.
- High-intensity training and weight lifting can also boost your testosterone levels.
- Manage stress as daily stress can lead to reduced production of testosterone.
- Increase vitamin D levels either through supplements or sunbath.
- Take all essential minerals and vitamins in a balanced amount.
- Optimize testosterone by sleeping at least 8 hours a day.
- Reduce the intake of alcohol and estrogen-like compounds.
- If these natural ways do not work for a man, then the best possible solution is testosterone replacement therapy (TRT).
What is testosterone replacement therapy?
TRT is one of the best-known solutions for restoring testosterone levels in men who are deficient in it. In this treatment, testosterone is inserted into the body in different ways, such as through injections, patches, gels, and medications. You can choose any of these options on your own, or the physician will suggest one based on what is the best for you. It reverses the effects of low T; for instance, your energy gets restored, libido improves, body or facial hair growth restarts, muscles and bone health improves, and normal red blood production starts.
How effective is testosterone replacement therapy?
Different men respond differently to this treatment. According to the guidelines by ACP (American College of Physicians), most men show improvement in their sexual functions such as sex drive, achievement of erection, etc., after getting this treatment. However, effects of testosterone replacement therapy differ from patient to patients. Overall TRT is considered to be safe and have a high success rate, please check out our study here.
How does testosterone replacement therapy work?
During this treatment, testosterone is injected into the body through different ways such as medications, gels, injections, etc. Once inside the body, the injected testosterone starts acting like normal body testosterone. It acts on different body cells, which recognize it like natural testosterone and perform the function testosterone tells them to perform.
Can anyone with low T have this therapy?
TRT causes prostate growth which may not be ideal for men suffering from the early stage of prostate cancer. That’s why men with prostate cancer should not opt for TRT. Doctors often make their patients have prostate screening before having TRT.
Other men who should also avoid TRT have the following health issues:
- Breast cancer
- Obstructive sleep apnea
- Congestive heart failure
- An enlarged prostate
How do I get started?
If you think you have low T, you should consult a doctor to get the best possible solution. Your doctor will first ask you about your symptoms and may have a physical examination. After this, he will run blood tests to diagnose low T. If you are diagnosed with TRT, the physician will guide you on different treatment options and tell you which treatment is right for you.
Are there any side effects of testosterone replacement therapy?
TRT is generally considered a safe treatment, but it also has some side effects. Some of the side effects of TRT include:
- An increase in the levels of red blood cells may lead to blood clot formation and heart attack if it is not controlled the right way.
- Oily skin and acne.
- Reduction in the number of sperms.
- Increase in the size of breasts.
- Testicles may reduce in size.
Can testosterone replacement therapy help me have children?
TRT is not a suitable treatment option for men who want to improve their fertility and have children. Though testosterone improves sex drive, it does not increase sperm count. In fact, it reduces the sperm count by reducing the production of another hormone called follicle-stimulating hormone (FSH), which is required for normal sperm production.
How often should testosterone levels be checked?
Once you start taking TRT, you will have to get your testosterone levels checked from time to time to make sure they are normal. Generally, physicians ask their patients to have a testosterone test after 6 to 12 months of getting the first TRT.
Do I need follow-up sessions?
You need regular checkups after you have your first TRT session. It is to ensure that you have normal testosterone levels and side effects of TRT are minimal compared to the side effects of having low testosterone. The prostate screening will be performed to check whether the prostate size is increasing or not. Blood tests will be performed to make sure the red blood cell level is normal. Testosterone dose may need to be changed based on your body’s response to the first dose that it received.
References / Scientific Studies / Further Reading
- Mulligan, T., Frick, M.F., Zuraw, Q.C., Stemhagen, A. and McWhirter, C., 2006. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. International journal of clinical practice, 60(7), pp.762-769.
- Carnegie, C., 2004. Diagnosis of hypogonadism: clinical assessments and laboratory tests. Reviews in Urology, 6(Suppl 6), p.S3.