Of Development Of Evidence
In this guideline, the task force made several statements to emphasize the importance of: informing the patient regarding potential benefits and risks of testosterone treatment and of monitoring treatment shared decision making general preventive care measures and basic principles of androgen deficiency screening, diagnosis, and treatment. They labeled these Ungraded Good Practice Statement. Direct evidence for these statements was either unavailable or not systematically appraised. The intention of these statements is to draw attention and remind providers of these principles .
The Endocrine Society maintains a rigorous conflict-of-interest review process for developing clinical practice guidelines. All task force members must declare any potential conflicts of interest by completing a conflict-of-interest form. The Clinical Guidelines Subcommittee reviews all conflicts of interest before the Societys Council approves the members to participate on the task force and periodically during the development of the guideline. All others participating in the guidelines development must also disclose any conflicts of interest in the matter under study, and most of these participants must be without any conflicts of interest.
When Should You Consider Testosterone Treatment For Ed
If youve had trouble having erections for three months, talk to your doctor. He or she will ask about all your symptoms and give you a physical exam. Symptoms of low testosterone can include less of a sex drive, loss of body hair, breast growth, needing to shave less often, a drop in muscle size and strength, and bones that break more easily.
If you have some of these symptoms, your doctor may have you get a blood test to measure your testosterone levels. The blood test should be done more than once. It is best to do it in the morning when testosterone levels are highest.
If the tests show that you have low testosterone levels, your doctor should look for possible causes. For example, the low levels might be caused by a problem in the pituitary glands.
If no other cause is found, you can try testosterone treatment.
This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
Evaluation For Determining The Etiology Of Hypogonadism
1.4 In men with hypogonadism, we suggest further evaluation to identify the etiology of hypothalamic, pituitary, and/or testicular dysfunction.
In men with secondary hypogonadism, clinicians should perform serum prolactin and iron saturation measurements, and in certain cases, pituitary function testing and magnetic resonance imaging of the sella turcica to determine the cause of gonadotropin deficiency.
In men with primary hypogonadism of unknown etiology, especially in those with testicular volume < 6 mL, clinicians should obtain a karyotype to diagnose KS.
When evaluating middle-aged and older men with secondary hypogonadism, the cost-effectiveness of pituitary imaging to exclude pituitary and/or hypothalamic disease is unknown. Surveys of middle-aged and older men with secondary hypogonadism and sexual dysfunction have revealed a low prevalence of hypothalamicpituitary abnormalities . Clinicians can improve the diagnostic yield of pituitary imaging to exclude pituitary and/or hypothalamic tumors by performing this procedure in men with panhypopituitarism, persistent hyperprolactinemia, serum TT < 150 ng/dL , or symptoms of tumor mass effect .
Many men with secondary hypogonadism have potentially reversible or treatable causes of gonadotropin suppression and low T concentrations or functional secondary hypogonadism that may be managed without need for testosterone treatment.
Values and preferences
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Avoid Medications That Lower Testosterone
Many drugs and medications reduce testosterone. Some, like opioids and anabolic steroids, greatly reduce the bodys production of testosterone. Corticoid steroids and taking too many NSAIDs contribute to reduced testosterone levels. Some drugs, like caffeine, actually may increase serum testosterone in men, but they also contribute to stress and interfere with sleep. Several over the counter, testosterone boosters/supplements may actually decrease testosterone production and can result in infertility.
How Is Low Testosterone Treated
Healthcare providers treat low testosterone with testosterone replacement therapy. Testosterone replacement therapy has several different forms, including:
- Testosterone skin gels: You apply the gel every day to clean, dry skin as directed. Its important that you dont transfer the gel to another person through skin-to-skin contact. Testosterone skin gels are one of the most common forms of treatment in the U.S.
- Intramuscular testosterone injections: You or a provider can administer the injections into a muscle every 1 to 2 weeks. Providers can administer long-acting testosterone by injection every 10 weeks. There are also subcutaneous injection options.
- Testosterone patches: You apply these patches every day to your skin as directed. You usually have to rotate their location to avoid skin reactions.
- Testosterone pellets: A specialist implants these pellets under your skin every three to six months. The pellets provide consistent and long-term testosterone dosages.
- Buccal testosterone tablets: These are sticky pills that you apply to your gums twice a day. The testosterone absorbs quickly into your bloodstream through your gums.
- Testosterone nasal gel: You apply a testosterone gel by applying it into each nostril three times a day.
- Oral testosterone: A pill form of testosterone called undecanoate is available for people with low testosterone due to specific medical conditions, such as Klinefelter syndrome or tumors that have damaged their pituitary gland.
- Skin irritation .
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In Most Cases Testosterone Treatments Are Not The Best Option For These Symptoms
A lot of medical conditions can contribute to low testosterone levels, Shukla said. Its important to make sure that youre not dealing with any underlying health issues. You want to really identify why youre experiencing those symptoms.
As he likes to frame it, maintaining your health is like maintaining your house. If you dont take care of the bones of the house, you can’t expect to add on to the house or put a lot of investment in the house.
Diabetes, kidney disease and a sedentary lifestyle could be contributing factors to these symptoms, as well as other chronic diseases.
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What Tests Will Be Done To Diagnose Low Testosterone
The following tests can help confirm low testosterone and determine the cause:
- Total testosterone level blood test: This test usually requires two sample collections between 8 a.m. and 10 a.m., when testosterone levels should be at their highest. If youre sick or have recently been sick, its important to tell your provider. Acute illness may cause a falsely low result.
- Luteinizing hormone blood test: This test can help determine if the cause of low testosterone is an issue with your pituitary gland.
- Prolactin blood test: High prolactin levels may be a sign of pituitary gland issues or tumors.
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What Happens If Low Testosterone Goes Untreated
Its common for people assigned male at birth to experience drops in their testosterone levels as they age. However, if these levels are significantly low, there can be a number of short-term and long-term symptoms that someone might experience.
Some of the most apparent symptoms of low testosterone could include ED, lowered sex drive, depression, difficulties focusing on tasks, and an increase in body weight. More long-term symptoms that might develop from untreated low testosterone levels could be a loss of muscle mass and a condition that weakens your bones known as osteoporosis.
How To Apply Testosterone Cream
The application procedure depends on the prescription instructions, although your typical application is once per day. Apply the cream at the same time daily, preferably when you can remember to do so. Immediately after drying off from your morning shower is a good time to do this.
Since different companies produce testosterone differently, your doctor will understand the nature of your prescription. Please read their instructions carefully and contact them immediately if you have any questions or concerns.
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Treatment And Delivery Systems
Testosterone replacement therapy aims at restoring hormone levels in the normal range of young adults and should, in theory, approximate the natural, endogenous production of the hormone produces and maintains physiologic serum concentrations of the hormone and its active metabolites without significant side effects or safety concerns and, more importantly, alleviates the symptoms suggestive of the hormone deficiency. However, the ultimate goals are to maintain or regain the highest quality of life, to reduce disability, to compress major illnesses into a narrow age range, and to add life to years.
Several different types of testosterone replacement exist including tablets, injections, transdermal systems, oral, pellets, and buccal preparations of testosterone. Selective androgen receptor modulators are under development but not yet clinically available.
The selection of the preparation should be a joint decision of an informed patient and physician.58 Short-acting preparations may be preferred over long-acting depot preparations in the initial treatment of patients with LOH.59 It has been recommended that the optimal serum testosterone level for efficacy and safety should be in the mid range to lower young-adult-male serum testosterone levels as the therapeutic goal.60 However, older males need higher levels to obtain a therapeutic benefit.
Is It Dangerous To Have Low Testosterone
Low testosterone is usually not dangerous, but very low levels of testosterone will result in muscle and bone loss, leaving men more at risk for fractures. Low testosterone in general is associated with a decrease in quality of life. Extremely low testosterone may increase the risk of cardiovascular events. However, it reduces the risk of an enlarged prostate or progression of prostate cancer.
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Testosterone Therapy For Low Levels
In most cases, men need to have both low levels of testosterone in their blood and several symptoms of low testosterone to go on therapy.
It is possible to have low levels and not experience symptoms. But if you do not have any key symptoms, especially fatigue and sexual dysfunction, which are the most common, it is not recommended you go on the therapy given the uncertainty about long-term safety.
Even if your levels are low and you have symptoms, low-t therapy is not always the first course of action. If your doctor can identify the source for declining levelsfor instance, weight gain or a particular medicationhe or she may first address that problem.
If you and your doctor think testosterone replacement therapy is right for you, there are a variety of delivery methods to consider, as found in the Harvard Special Health Report Men’s Health: Fifty and Forward.
Most men feel improvement in symptoms within four to six weeks of taking testosterone replacement therapy, although changes like increases in muscle mass may take from three to six months.
Benefits Of Testosterone Replacement Therapy
Because Low T Center takes a holistic approach to mens healthcare, our medical professionals can proactively address other conditions youre currently experiencing or could experience later on, including sleep apnea or allergies. These conditions may also affect testosterone levels.
Our providers get to know you on a personal level and gather important health data often to assess progress with greater efficiency.
At Low T Center, we focus on treating your symptoms of low testosterone levels, so you can rediscover the best version of yourself.
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Which Drugs Help To Increase Testosterone Production
Estrogen blockers are used to increase testosterone production. An alternative to testosterone replacement, estrogen blockers are used in young men with low testosterone and older men with age-related low testosterone. For young men, estrogen blockers dont reduce fertility in the same way as testosterone replacement. For older men, estrogen blockers are used when they arent candidates for testosterone because of heart disease or prostate cancer.
Symptoms Of Low Testosterone
As we age, our bodies undergo a long list of changes that may be uncomfortable for both our minds and our bodies. Many of these can be attributed to hormones, like testosterone, and others can be caused by the choices we make every day.
To determine if low testosterone is the primary cause of your symptoms, youll want to discuss everything youre experiencing with your doctor. Some of the most common symptoms of low testosterone are:
Because these symptoms could also be related to other conditions or lifestyle choices, its essential to discuss other possible causes with your doctor before deciding on a treatment. Common complaints like erectile dysfunction and hair loss, for example, may be related to other hormones, lifestyle factors, or a separate health condition.
An expert hormone health practitioner will be able to determine which of your symptoms can be attributed to low testosterone. Through thorough clinical evaluation, theyll help you decide whether treating low testosterone will be the best course of actionand how to treat it.
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Should I Be Screened For Prostate Cancer
Prostate cancer screening is controversial. Some doctors and organizations recommend regular screening while others don’t.
The American Cancer Society says men should talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested. The group’s guidelines make it clear that prostate-specific antigen blood testing should not occur unless this discussion happens. The discussion about screening should start at age 50 for most men with average risk for prostate cancer and earlier for men at higher risk.
The American Urological Association recommends that men ages 55 to 69 who are considering screening should talk with their doctors about the risks and benefits of testing and proceed based on their personal values and preferences. The group also adds:
- PSA screening in men under age 40 is not recommended.
- Routine screening in men between ages 40 and 54 at average risk is not recommended.
- To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have decided on screening after a discussion with their doctor. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.
- Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.
Low Testosterone Fast Facts
Low testosterone is linked with many other health problems, such as high blood pressure, high cholesterol, obesity, and diabetes.
The FDA has approved testosterone therapy for men with low T due to disorders of the testicles, pituitary gland, or brain.
Fatigue alone is not a reason to get testosterone therapy, despite all the Are you tired? commercials for testosterone drugs.
A man can develop low T at any age.
Low testosterone can affect mood, energy levels, fertility, and other aspects of a mans life.
Dr. Eleswarapu has no disclosures. Dr. Mezitis has no disclosures.
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Better Cognition And Memory
Memory is the most fragile mental function, and with testosterone levels naturally decreasing as men age, information is processed less carefully and details often slip. However, numerous studies have shown that patients with lower testosterone levels showed improvements in memory after testosterone supplementation.
What Is The Best Treatment For Low Testosterone
Low testosterone, also known as low-T, can occur as a result of injury, surgery, or chronic illness and cause a host of symptoms that compromise your quality of life. But the most common cause of low testosterone isnt an accident or illness its aging. And the symptoms are no less serious because theyre driven by a natural process.
After a man reaches peak testosterone levels around his late 20s, the body gradually decreases testosterone production at a rate of 1-2% per year. The resulting changes may be undetectable at first. But by the time you reach the age of 40 or 50 , you may start noticing a significant difference in the way your body performs. May be due to andropausealso known as male menopause.
If youre struggling with low libido, low energy, and low mood, you may be experiencing the effects of low-T. But before seeking treatment, its important to determine whether low testosterone is indeed the cause of your discomfort. An expert hormone practitioner will thoroughly evaluate your symptoms and complete comprehensive lab testing. If your testosterone levels are low, theyll work with you to create a treatment plan, combining proven medications with alternative remedies as needed. And theyll discuss all the risksand benefitsassociated with the best treatment for low testosterone: testosterone replacement therapy.
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Will I Be Able To Fully Replenish My Testosterone
Fully replenishing your testosterone level depends largely on what treatments you explore a your doctor. If you choose to go a more natural route with changes to your diet and exercise routine, you may see an increase in your T levels, but its highly unlikely that youll be able to get back to the levels you were at in your 20s with diet, exercise, and supplements alone.
Testosterone creams and injections can replace a significant amount of lost testosterone, but since each person reacts differently to these treatments, its possible that your T levels wont be fully replenished.
More importantly, its worth discussing the side effects and results of overusing these replacement therapies. You should never increase your dose or the frequency of use without talking with a doctor first. Severe side effects from misusing these treatments can include stroke, heart attack, a higher risk of prostate cancer, liver conditions, and an enlarged prostate.
The Prostate And Testosterone Replacement Therapy
In aging men with late-onset hypogonadism, TRT may normalize serum androgen levels but appears to have little effect on prostate tissue androgen levels and cellular functions266 and causes no significant adverse affects on the prostate.267 At the present time, there is no conclusive evidence that testosterone therapy increases the risk of prostate cancer or benign prostatic hyperplasia .45,268,269
Benign prostatic hyperplasia
Finally, although there are no compelling data to suggest that testosterone treatment exacerbates lower urinary tract symptoms or promotes acute urinary retention, severe LUTS, due to BPH, represent a relative contraindication which is no longer applicable after successful treatment of lower urinary tract obstruction.45
Prostate cancer is well known to be, in the majority of cases, an androgen sensitive disease, and prostate cancer has been treated in patterns designed to lower testosterone levels.270 Androgen replacement therapy is an absolute contraindication. There is also no good evidence that testosterone treatment will convert subclinical prostate cancer to clinically detectable prostate cancer,45 although some case reports reported this correlation.274,275 In a retrospective analysis of hypogonadal men who underwent prostate biopsy prior to testosterone replacement therapy, no increase in the risk of prostate cancer in men was revealed compared to those without prostatic intraepithelial neoplasia at baseline.276
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