Testosterone Replacement Therapy For Low Testosterone
Hormone Replacement Therapy
When the cause of low testosterone is testicular failure, testosterone replacement therapy can help reestablish sexual function, inhibit bone loss, and rebuild muscle strength, while also boosting sex drive, energy, and confidence. Testosterone replacement therapy for low testosterone comes in numerous forms:
- Injections: These are given in the muscle roughly every two weeks .
- Patch: This hormone patch is applied to the back, upper arm, thigh, or abdomen every night.
- Gel: A gel containing testosterone is rubbed into the skin. Skin-to-skin contact with anyone should be avoided until the gel is dry.
- Oral: In this approach, the testosterone is applied where the upper lip and gum line connect. But this method is not good for long-term use because it could increase the risk of a heart attack, cause liver damage, and raise cholesterol levels.
- Pellets: Testosterone pellets are new to market and consist of tiny, compressed cylinders of testosterone that are injected into the fat of the buttocks, just below the waistline, and are absorbed into the skin over a few months.
Complications and Side Effects of Hormone Replacement
For many patients, testosterone replacement therapy can make a manâs breastâs larger, speed up prostate growth, and increase the number of red blood cells. Other known side effects include:
- Fluid retention
- Urinary changes, including a slow urine stream or frequent urination
- Increased breast size
What Kind Of Doctor Should You See For Low Testosterone
Written by Elite HRT on March 16, 2021
Camille Freking, Regulatory Affairs Specialist, MEDICAL ADVISOR
Starting treatment for low testosterone can be an intimidating time, especially if you do not know anyone that has gone through it. Because it is not something that you have likely experienced before it can be difficult to know where to start and who you should see for help with your low T.
One great thing is that there are many options for healthcare providers that can help and you have the opportunity to make the choice that is best for you. The more you know about the whole process the less stressful it becomes.
Keep reading to learn more about the different care providers you can work with for low testosterone, when to see a doctor, and what the process of the first visit and treatment will be like.
What Tests Does An Endocrinologist Do
Your endocrinologist may request imaging exams to look at your endocrine system function. Thyroid ultrasound imaging may be used to look at your thyroid’s structure. A fine-needle aspiration can help rule out cancer in a thyroid nodule. A thyroid scan shows the size, shape and function of the thyroid gland.
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Low Testosterone Treatment In Phoenix Arizona
For first-rate low testosterone treatment in Phoenix, Arizona, visit us at Ironwood Urology. Our board-certified urologist, Dr. Desiderio Avila, Jr., has helped scores of men struggling with low testosterone and other urological or reproductive tract issues live healthier lives.
Give us a 961-2323 or fill out our convenient online request form to schedule a consultation with the one of the best urologists in Phoenix. Dr. Avila takes great pleasure in providing you with the highest quality of care!
How To Find A Doctor To Prescribe Testosterone Replacement Therapy
The testosterone used in T-therapy requires a prescription. And like any other prescription medication, you must have a diagnosis and legitimate medical need before a doctor can legally prescribe testosterone therapy for you.
Before any doctor can write you a prescription for testosterone therapy, he or she must have your testosterone tested. If your testosterone blood test indicates that your testosterone levels are lower than they should be for your age, your doctor will be able to give you a prescription for testosterone therapy.
Testosterone therapy can be given in skin patches, topical gels, or intramuscular injections. Most testosterone doctors agree that injections are the most effective method for administering T-therapy.
If you and your testosterone replacement doctor decide that injections are best for your needs and lifestyle you will be taught everything you need to know to safely give yourself your testosterone replacement injections.
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Is It Hard To Find The Right Doctor For Testosterone Therapy
It does not have to be hard to find a doctor to prescribe testosterone therapy for you. In fact in can be summed up in four easy steps:
Step One Evaluate your symptoms of low-T
Step Two Have a physical exam and your blood tested for your testosterone level
Step Three Evaluate your test results and if you are found to have low-T receive your prescription for testosterone therapy
Step Four Fill your prescription for testosterone therapy and begin an individualized program tailored to your unique needs and lifestyle.
Remember, any kind of doctor can write you a prescription for testosterone therapy. However, it is highly recommended that you only get your testosterone therapy from a medical professional whose practice is dedicated to hormone replacement therapy. Only a well-qualified physician who specializes in hormone replacement therapy, should prescribe your testosterone therapy. This way you can be sure your testosterone therapy will be the safest and most effective for your particular needs and lifestyle.
When you get your HGH Human Growth Hormone therapy from a doctor who specializes in age optimization through hormone replacement, not only will such a physician be able to provide you with the most accurate testing of testosterone levels and provide you with the most effective prescription testosterone treatment, he or she will also be able to evaluate your other hormones.
How Do I Talk To My Doctor About Low Testosterone
It may not be easy to speak to a doctor about the need for testosterone therapy. It can be embarrassing to feel like less of a man, particularly because one of the first and most common signs of low-t is loss of sex drive, and/or erectile dysfunction. This is all the more reason why you should seek your testosterone treatments from a doctor who specializes in hormone replacement for men. As well as being better equipped to interpret all of your symptoms, he will be more conscious of the self-esteem issues that could also come along with low-T. Still when talking to any doctor about low-T, you must be confident enough to tell him or her all about your symptoms. Do not leave anything out because you believe it may not be important, or may be embarrassing. In the long run, doing so, will only keep you from getting the best testosterone therapy possible.
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Endocrinology Diabetes And Thyroid Specialists Located In Houston Tx
About 40% of men over the age of 45 experience low testosterone or male hypogonadism. If youre experiencing symptoms like erectile dysfunction, decreased muscle mass, or low energy, dont wait to seek treatment. At The Endocrine Center, with three offices in Houston, Texas, the team of board-certified endocrinology, diabetes, and thyroid specialists treat low testosterone and offer testosterone injections. Book online to schedule an appointment or call the Main Campus, Methodist West, or Greater Heights office today.
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Determination Of Adherence To Guidelines
To assess interdisciplinary adherence to the established guidelines, observed practice patterns of the providers were compared with those recommended by the Endocrine Societys Clinical Practice Guidelines published in 2006 and updated in 2010 . The guidelines suggest that before prescribing TRT, providers should twice confirm low morning serum total testosterone levels after excluding reversible illness, drugs, or nutrition deficiency as a cause of low testosterone levels. The repeat testosterone screen should be accompanied by a test for serum luteinizing hormone and follicle stimulating hormone . Free or bioavailable testosterone can also be used to determine low values if sex hormone-binding globulin is thought to be abnormal. If LH or FSH is low or normalsuggesting secondary hypogonadismthen prolactin/other pituitary hormone levels are recommended.
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What Is Low Testosterone
Testosterone is a hormone produced by both genders, but men have much higher levels. Research shows that testosterone plays an important role in the development of male features, including increased muscle mass, body hair, and a deep voice.
Throughout your life, the levels of testosterone in your body fluctuate. After the age of 30, your testosterone decreases by about 1% each year. While this loss of testosterone is completely natural, some men experience testosterone levels that are abnormally low.
When left untreated, low testosterone can trigger a variety of uncomfortable symptoms and negatively affect your quality of life.
When Should I Seek A Doctor For Testosterone Injection Therapy
As you age your testosterone level naturally declines. Once you are over 30, the decline in testosterone can lead to a number of debilitating conditions that collectively are known as male menopause or andropause.
If you are looking for a doctor to provide testosterone therapy, chances are you are a man between the ages of 35 and 65, who has started to feel the symptoms of low testosterone.
The signs and symptoms of low testosterone in men include:
- Weight gain, even when eating right and exercising
- Foggy thinking or other cognitive issues
- Irritability, mood swings, and/or depression
Even when you have found the right kind of doctor to evaluate your symptoms, do not expect him or her to immediately write your prescription for testosterone therapy.
Prescriptions for testosterone therapy are not written lightly by ethical doctors. Before you are given testosterone therapy, any legitimate doctor will need to take a complete medical history and physical exam, which will then be followed with a specialized blood test to check for your testosterone levels.
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How Will My Doctor Treat Low Testosterone
If youre experiencing symptoms of low testosterone, your healthcare provider will run a blood test to check your testosterone levels.
Symptoms of low T can include:
A testosterone number less than about 250 nanograms per deciliter is considered low. But a number isnt necessarily something that needs treatment. Treatment for low testosterone isnt recommended unless you have low numbers and symptoms of low T.
People should not be treated for low numbers and no symptoms or symptoms but no low number. The two really need to go together, Dr. Pantalone stresses.
If you show symptoms and your testosterone levels are indeed low, your healthcare provider will likely recommend lifestyle changes, testosterone therapy and additional testing.
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Do Urologists Treat Low Testosterone
Low testosterone signals towards a medical condition named hypogonadism in males. It is defined by the deficient production of testosterone and sperms due to either underactive male sex gonads i.e. testes or underactive pituitary gland or hypothalamus. The pituitary gland and hypothalamus regulate the secretion of testosterone by the testes through the production of hormones stimulating the gonads. Low testosterone causes symptoms like delayed puberty, impaired development of masculine features diminished sex drive, infertility, and erectile dysfunctions.
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Sex Steroid Actions Beyond Circulating Testosterone
It is well recognized that relating a serum testosterone level to a clinical phenotype is an oversimplification, given that circulating testosterone levels, whether free or total , are unlikely to accurately reflect androgen action at the tissue level. Indeed, testosterone not only directly transactivates the AR but also acts via dihydrotestosterone and estradiol . DHT may mediate, at least in part, the metabolically favorable changes in body composition observed with testosterone therapy because, in a recent RCT of healthy men, DHT treatment significantly increased lean body mass and decreased fat mass, despite decreasing total testosterone to less than 5 nmol/liter . Furthermore, testosterone action is modulated by AR polymorphisms , as well as by transcriptional cofactors , likely in an age- and tissue-dependent fashion. Not surprisingly, therefore, circulating testosterone concentrations account for only 4067% of the variance in fat-free mass and muscle size . In addition, local androgen synthesis and inactivation may not be reflected in circulating testosterone levels .
Lifestyle Measures: Effects On Testosterone Levels
Given increasing evidence that obesity and disease are major determinants of the age-related decline in testosterone, it is not surprising that this decline can be at least partially prevented, or even reversed, by successful lifestyle measures. Indeed, weight loss, whether by diet or surgery, leads to substantial increases in total testosterone, especially in morbidly obese men, proportional to the amount of weight lost . Free testosterone rises less consistently, due to the concomitant increase in SHBG . One study suggests that even smaller degrees of weight loss in only mildly overweight men significantly increase testosterone levels . This disproportionate increase in testosterone relative to weight loss may have occurred because weight loss was achieved by exercise. Indeed, several uncontrolled studies have shown that exercise itself can increase testosterone by up to 30%, especially acutely . Moreover, the weight loss-induced increase in testosterone is associated not only with decreased insulin resistance but also with improved sexual function and lower urinary tract symptoms . However, the effect of lifestyle measures on testosterone in men with only mild obesity requires further study.
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Responses To The Survey Questionnaire
Initial Workup. Initial biochemical testing required by the participants is shown in . Total T was the initial blood test required by most participants. However, whereas 70% of the endocrinologists included measurement of pituitary hormones levels in their initial assessment, only 35% of urologists required these additional measurements . In addition, 37.5% of endocrinologists ordered a measurement of the SHBG level . When asked about conditions required for blood testosterone sampling, most respondents specifically required morning testing , but only 29% of endocrinologists and 10% of urologists would order for fasting sampling. 48% of urologists and 58% of endocrinologists were aware of the importance to test testosterone levels at a safe distance from any acute disease. Overall when analyzed by seniority, younger physicians were more informed of this point than their older colleagues . Figure 3 shows the additional tests the participants would send, assuming that the initial TT level was borderline or low. It should be noted that only 44% and 45% of the endocrinologists and urologists, respectively, will ask for a repeat TT measurement, but significantly more endocrinologists, compared with urologists, will require other androgen testing: free androgen index, SHBG, or bT . In contrast to the hormone tests required at the beginning , at this step, a similar number of endocrinologists and urologists will obtain pituitary hormone level measurements .
What Does A Testosterone Prescription Look Like
Testosterone prescriptions look pretty much like prescriptions for other drugs. A prescription for testosterone will include your doctors name, address, and contact information the Drug Enforcement Administration number your own name, age, and address and the date of issue. This is standard. The most important part of your prescription for low testosterone is where the doctor details your treatment: how many mg/ml the substance should contain, how much of it and how many times a day you should take it, the number of mls you can get for one fill, and the number of refills you are allowed.
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Testosterone Therapy For Hypogonadism Guideline Resources
Full Guideline: Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice GuidelineJCEM | March 2018
Shalender Bhasin, Juan P. Brito, Glenn R. Cunningham, Frances J. Hayes, Howard N. Hodis, Alvin M. Matsumoto, Peter J. Snyder, Ronald S. Swerdloff, Frederick C. Wu, Maria A. Yialamas
Differences between the 2010 and 2018 guidelines:
- More rigorous appraisal of testosterones efficacy and safety using RCTs published during the last three years.
- Points out continuing uncertainty about the benefits and risks of testosterone therapy as well as suboptimal testosterone prescribing practices.
- Highlights the importance of an appropriate diagnostic work up and monitoring plan.
Diagnosis and Treatment of Male Hypogonadism | ENDO 2018