TRT and Men’s Health Management

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Testosterone is an important hormone that controls different processes, such as fat distribution, sex desire, bone density, red blood cell formation, and muscle mass. Any fluctuation in its normal concentration can adversely affect your mental, physical and emotional health.

Healthcare professionals often prescribe TRT to men with low T. This FDA-approved procedure involves the administration of exogenous testosterone to help men restore their testosterone levels and feel like their best selves again.

In this article, we have explained TRT in detail, including its effects on your health, diagnosis, treatment options, etc., to help you understand why it has become an important part of men’s health management today.

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TRT: When and why to have this therapy?

As mentioned earlier, TRT is prescribed to men whose bodies are unable to produce testosterone in healthy amounts for one reason or another. We will discuss its common causes in the next sections, but it is essential to first learn what low T does to the body.

Men suffering from low T often report the following symptoms.

• Low sex desire
• Trouble getting and maintaining an erection
• Low sperm count
• Loss of muscle mass
• Accumulation of body fat
• Poor bone density
• Loss of body hair
• Hot flashes
• Reduction in the size of testicles
• Anxiety
• Depression
• Poor self-esteem
• Lack of energy

These symptoms negatively influence the quality of men’s lives. For instance, if you are in a romantic relationship, poor sexual performance may disturb your relationship with your partner. Similarly, losing self-confidence could result in fewer social interactions, influencing your social life.

Men experiencing these symptoms should discuss their condition with their healthcare provider to find a suitable solution fast and start their journey to recovery.

Effects of Testosterone on the body and quality of life

TRT is one of the most effective ways of getting rid of the symptoms mentioned above and improving the quality of your life. Studies indicate men experience the following benefits once they start taking testosterone.

• Improvement in the lean muscle mass
• Improvement in bone density and strength
• Improvement in body fat distribution
• Restored sex drive
• Enhanced sense of well-being

Improvement in low T symptoms can have a significant impact on the quality of your life. It makes it easier to perform day-to-day activities, and it may also enhance your work performance. You will regain the lost confidence, and your social life will also be improved.

How does TRT work?

If you have low testosterone levels, you should consult a doctor and start a suitable treatment as soon as possible. Your doctor will first identify the actual cause of the problem and then create a treatment plan accordingly. They will monitor your testosterone levels throughout the treatment to ensure you achieve maximum results and have the least side effects.

Diagnosis

Low T can be due to primary hypogonadism or secondary hypogonadism.

Primary hypogonadism: It occurs when there is a problem with your testes. Your hypothalamus and pituitary gland keep sending signals to testicles to initiate testosterone production, but they fail to perceive those signals.

Its common causes are:

• Injury to testes
• Testes infection
• Testicular cancer
• Klinefelter Syndrome
• Undescended testicles
• Cancer treatment
• Hemochromatosis

Secondary hypogonadism: It occurs when the testicles are healthy, but there is a problem with either the hypothalamus or the pituitary gland. They do not release hormones that activate testosterone secretion. Hence, the testes fail to produce healthy amounts of testosterone.

Common causes of secondary hypogonadism are:

• Hypothyroidism
• Hypothalamic or pituitary tumour
• Inflammatory disease
• Pituitary disorder
• Kallmann’s syndrome
• AIDS
• Obesity
• Certain medications
• Certain medications

Diagnosing the actual cause is important as it helps the doctor design a suitable treatment plan.

TRT blood test

Your doctor will conduct a complete TRT blood test. The blood sample will be taken in the morning. It will find concentrations of the following elements in your blood.

Total testosterone: It is the sum of free or unattached and bound testosterone. Healthy testosterone amounts range from 300 to 1,000 nanograms per deciliter (ng/dL).

Free testosterone: It is the biologically active form of testosterone that can enter cells and carry out different functions.

Gonadotropin-releasing hormone: It is released by the hypothalamus to stimulate testosterone production. Its low level in blood may indicate a problem with the hypothalamus.

Luteinizing hormone (LH): It is secreted by pituitary glands and stimulates testosterone production. Low LH levels indicate that there might be a problem with the pituitary gland.

Prostate-specific antigen: TRT may increase your prostate-specific antigens (PSA). That is why PSA levels are recorded at the start of the treatment. They are later compared with levels during the treatment.

Full blood count: It gives information about your blood cells. Raised red blood cells may increase the risk of heart attack or heart disease.

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Physical examination and evaluation

The doctor will conduct a physical examination to look for the signs of low T. They will also ask questions to understand what you feel about your condition. Inform them about your medical history and how you have noticed physical or emotional changes in yourself.

MRI

MRI of the brain will be done to exclude pituitary gland tumours.

Ultrasound

It will be done to exclude testicular infections.

Testosterone administration routes

If you have been diagnosed with low T, your doctor will prescribe you testosterone doses based on your current testosterone levels. There are three ways to administer testosterone.

Subcutaneous: It is testosterone administration in the area between muscle and skin. The area is less vascular; thus, absorption through it is potentially slower.

Intramuscular: It involves the injection of testosterone into muscles. Absorption through muscles occurs fast because of the high vascularity of muscles.

Topical: Creams or gels are applied directly to the skin from where testosterone gets absorbed into the bloodstream. It is the least invasive mode of administration.

Treatment options

There are different forms of TRT. Ask your doctor to explain the pros and cons of each form so you can choose the best one. Here are the most commonly used testosterone treatment options.

Testosterone gel

It is one of the most convenient forms of TRT. You need to rub testosterone gel daily on your dry and clean body part that is easy to cover with clothing. Doctors usually suggest upper thighs, upper arms, and shoulders for gel application.

Follow the instructions written on the gel packaging to use the product right away. Testosterone gel can catch fire, so stay away from the fire until the gel dries.

Testosterone gel and HCG

Your doctor may combine testosterone gel with the HCG (human chorionic gonadotropin) if you want to maintain your fertility and sperm count and prevent testicular shrinkage. This hormone will increase the production of natural testosterone from Leydig cells.

Testosterone Enanthate

The injectable form of testosterone is given every 1 to 4 weeks. It has a slow release rate, and its dosage is determined based on your testosterone levels when starting the treatment. It should always be given in muscles and never in veins because administration in veins can significantly reduce its efficiency.

Testosterone patches

Testosterone patches are applied directly to the skin. A patch is usually applied at the same time daily and left in place for the next 24 hours, after which a fresh patch is applied.

Testosterone pellets

These are small grain-size pellets that are implanted under the skin. They contain crystallised testosterone that is released into the bloodstream slowly and steadily for up to 6 months. The pellet is implanted under the skin through a minor procedure under the supervision of a healthcare professional.

Testosterone monitoring

Your doctor will alter your testosterone doses and the frequency of administration to manage TRT side effects, including acne, obstructive sleep apnea, enlarged breasts, and increased red blood cell count.

In the beginning, They will ask you to closely examine your body and treatment side effects and contact them immediately if you experience any severe side effects. They may ask you to come for a monitoring session after 3 to 6 months of starting TRT.

During this session, they will evaluate your testosterone levels, prostate-specific antigen level, and red blood cell count. They will ask you to fill out a questionnaire. They may bring a few changes to the treatment based on his evaluation.

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Conclusion

TRT has become a part of men’s health management programs because of its incredible benefits. It can help them reduce hypogonadism symptoms and improve the quality of their lives.

Men suffering from hypogonadism should discuss the issue with their healthcare provider to start their recovery journey and enjoy the benefits of TRT. Their doctor will diagnose the actual cause of the condition and create a unique treatment plan that best suits their needs.

References/Scientific studies/Bibliography/Further reading 

Bassil, N., Alkaade, S. and Morley, J.E., 2009. The benefits and risks of testosterone replacement therapy: a review. Therapeutics and clinical risk management, 5, p.427.

Moon, D.G. and Park, H.J., 2019. The Ideal Goal of Testosterone Replacement Therapy: Maintaining Testosterone Levels or Managing Symptoms?. Journal of Clinical Medicine, 8(3), p.362.

Corona, G., Torres, L.O. and Maggi, M., 2020. Testosterone therapy: what we have learned from trials. The journal of sexual medicine, 17(3), pp.447-460.

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