Cardiovascular And Cerebrovascular Risks Of Trt
Two widely established health risks associated with TRT are polycythemia and reduced HDL cholesterol. These risk factors represent increased risk for CV and cerebrovascular events. Serious concern regarding the safety of TRT was raised in 2010 when the data and safety monitoring board of a double-blind randomized clinical trial recommended discontinuation of the trial because elderly hypogonadal men experienced an increased incidence of CV events after receiving TRT. This randomized clinical trial was discontinued because 23 participants in the TRT group vs 5 participants in the placebo group experienced adverse CV-related events within the first 6 mo. Adverse events ranged from chest pain to myocardial infarction , with peripheral edema being the most commonly reported side-effect .
As a response to the above study reports, the United States Food and Drug Administration the Endocrine Society and the United States Veterans Administration have called for monitoring and reassessing the health risks associated with TRT, respectively. Since these advisory announcements, a number of literature reports have critiqued the TRT literature, particularly the studies by Vigen and Finkle, for issues associated with the study design, statistical methods, and interpretation of findings.
Testosterone Replacement Therapy For Women
Androgens like testosterone are naturally produced by the ovaries, adrenal glands, and cells/tissues throughout the body. If you are found to have lowered levels of testosterone, this could be linked to any number of factors, including:
- Menopause and the natural aging process
- Ovarian dysfunction
- Amenorrhea or other menstrual cycle problems
- Inflammation in your body
- Adrenal failure
Depending on the cause of lowered testosterone and the symptoms you experience, your doctor may suggest testosterone replacement therapy. Similar to male TRT, the goal would be to restore your levels to the amount of testosterone thats naturally present in healthy women of child-bearing age.
No testosterone preparations have yet been FDA-approved for use in women in the United States, but you can receive a prescription for these medications from compounding pharmacies, usually in the form of pellets, creams, or gels. Some hormone practitioners might also prescribe a DHEA medication in order to supplement the precursor hormone to testosterone in the female body.
Do You Consult A Urologist Or Endocrinologist For Low Testosterone
A primary care physician may refer an individual to a urologist, who specializes in diseases of the male reproductive system, or to an endocrinologist who specializes in hormone-related diseases.
According to a 2018 , urologists seemed to adhere more consistently than other specialists to established guidelines for the screening and treatment of low testosterone in males.
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Signs And Symptoms Of Low Testosterone In Men
Medically reviewed by Vicky Davis, FNP
Of testosterones many roles in human function and development , most of us know it as the hormone that turns boys into men.
Testosterone is responsible for several key functions in your body, from the development of your voice, hair and genitals to maintaining your sexual function and fertility.
It also plays a significant role in your mental health and wellbeing, helping to manage everything from your mood to your level of interest in sex.
The male body produces testosterone at a rate specific to each individual. But what can happen when your body doesnt produce enough?
Below, weve listed several signs that you may experience if your testosterone levels are on the lower side of normal, from changes in the way you think and feel to physical changes that might affect your muscles, bones and even your sexual performance.
Weve also talked about what you can do if you think you might have low testosterone and want to take action and treat it.
Does Low Testosterone Affect Fertility
About 15% of men with fertility problems have low testosterone levels.
However, low testosterone does not cause infertility. In people with fertility problems, low testosterone may be a symptom of a testicular function issue causing infertility rather than a cause of infertility itself.
For example, testicular atrophy can cause infertility and also reduce a persons testosterone levels. In this instance, the low testosterone levels are a symptom of an underlying condition, not a cause of infertility.
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What Are The Effects Of An Undescended Testicle
An undescended testicle can affect a mans fertility if left untreated. The higher temperature inside his body can affect his testicles development and sperm production. Men with two undescended testicles are more likely to experience fertility-related issues than men with only one undescended testicle.
Men with an undescended testicle are more likely to develop an inguinal hernia. This causes their intestine to push out through a weakened area in their abdominal wall. Only surgery can correct this painful condition.
Undescended testicles are also a risk factor for testicular cancer, even when theyre corrected. This is true for both the descended and undescended testicle.
What Treatment Options Exist For Low T
Fortunately, the ravaging effects of low T can be mitigated or avoided in most patients who receive therapy to correct the hormonal imbalance before it becomes a major health burden. The most common treatment for low testosterone, as we mentioned earlier, is called testosterone replacement therapy .
Two primary types of TRT are performed on US patients. They are:
- Bioidentical hormone replacement. In this therapeutic modality, hormonal pellets are inserted under the skin, where they gradually release a type of testosterone referred to as bioidentical that mimics the molecular structure of naturally-occurring testosterone in the body.
- TRT with synthetic testosterone. This type of TRT typically involves regular injections of synthetic testosterone in patients over the course of several months, although other delivery methods exist that we will explore below.
The testosterone utilized in TRT can be administered in the following forms:
*Testosterone injections represent the most affordable and widely effective form of TRT due to their introduction directly into the bloodstream via muscle tissue.
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Prostate Related Risks Of Trt
Another well-established health risk of TRT is increased incidence of prostate/lower urinary tract-related events . Several coauthors of this commentary recently conducted a double-blind randomized clinical trial and observed that TRT produced a 40% prostate enlargement in older hypogonadal male Veterans over 12 mo. These increased prostate-related risks have raised concern that TRT may increase prostate cancer risk or hasten the development of undiagnosed prostate cancer.
However, no published analysis has reported measurable increases in prostate cancer risk or Gleason score in men undergoing TRT, or in hypogonadal men with a history of prostate cancer undergoing TRT. Despite this, Calof et al estimated that an evaluation of 85862 participants is necessary to detect a hypothetical 20% increase in prostate cancer resulting from TRT. The largest meta-analysis evaluating prostate cancer risk associated with TRT included only 1700 men .
What Is Low Testosterone
Low testosterone is a condition in which your testicles dont produce enough testosterone . Testicles are the gonads in people assigned male at birth . More specifically, the Leydig cells in your testicles make testosterone.
Low testosterone causes different symptoms at different ages. Testosterone levels in adults AMAB naturally decline as they age. This includes cisgender men, non-binary people AMAB and transgender women who arent undergoing feminizing hormone therapy.
Other names for low testosterone and male hypogonadism include:
- Testosterone deficiency syndrome.
- Sexual and reproductive function.
Your body usually tightly controls the levels of testosterone in your blood. Levels are typically highest in the morning and decline through the day.
Your hypothalamus and pituitary gland normally control the amount of testosterone your testicles produce and release.
Your hypothalamus releases gonadotropin-releasing hormone , which triggers your pituitary gland to release luteinizing hormone . LH then travels to your gonads and stimulates the production and release of testosterone. Your pituitary also releases follicle-stimulating hormone to cause sperm production.
Any issue with your testicles, hypothalamus or pituitary gland can cause low testosterone .
What is a low testosterone level?
The American Urology Association considers low blood testosterone to be less than 300 nanograms per deciliter for adults.
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What Are The Health Effects Of Low Testosterone
Testosterone is critical for a number of biological functions, most notably for the reproductive health of both men and women, but also for metabolism, mood regulation, and cardiovascular optimization. Below, well describe the most concerning effects of decreased testosterone levels in men and women, respectively.
Diseases And Conditions That Affect Testosterone
Men can experience a drop in testosterone due to conditions or diseases affecting the:
- Testes direct injury, castration, infection, radiation treatment, chemotherapy, tumors
- Pituitary and hypothalamus glands tumors, medications , HIV/AIDS, certain infections and autoimmune conditions
Genetic diseases, such as Klinefelter syndrome and hemochromatosis can also affect testosterone.
Women may have a testosterone deficiency due to diseases of the pituitary, hypothalamus or adrenal glands, in addition to removal of the ovaries. Estrogen therapy increases sex hormone binding globulin and, like aging men, this reduces the amount of free, active testosterone in the body.
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What Happens When You Start Taking Testosterone
Hormonal changes
Normal testosterone metabolism results in the formation of two primary metabolites, namely, DHT and estradiol .
Elevated levels of DHT can cause:
- Benign growth of the prostate
- Increased oiliness of the skin and acne
- Male pattern balding
- Low testosterone levels, erectile dysfunction, and a decrease in free testosterone
Prostate changes
People with a first-degree relative diagnosed with prostate cancer, as well as those with an elevated prostate-specific antigen level, should proceed with caution and be closely monitored.
Treatment should not be considered for men who have a personal history of prostate cancer. TRT does not cause prostate cancer, but it is possible that elevated testosterone levels can cause an otherwise undetected prostate cancer lesion to grow more aggressively.
Fertility problems
When testosterone levels are restored, either naturally or through treatment, the brain reduces the stimulus to produce testosterone by secreting less gonadotropin-releasing hormone . Because this single hormone regulates both follicle-stimulating hormone and luteinizing hormone, the natural suppression of GnRH can reduce fertility. Furthermore, this process is responsible for the shrinkage and change in firmness in the testicles.
Erythrocytosis
According to studies, TRT causes increased RBC count that can make the blood more viscous. Hematocrit levels higher than 54.0% increase a persons risk of:
- Abnormal clotting
How Is An Undescended Testicle Diagnosed
Your childs doctor may be able to palpate, or feel, his undescended testicle in his abdomen. In other cases, the testicle cant be felt. In some cases, the testicle isnt present at all.
An X-ray or ultrasound imaging test may help your childs doctor diagnose an undescended testicle. Imaging scans, including an MRI with contrast dye, can confirm the presence or absence of his testicle.
Two conditions can mimic an undescended testicle. A retractile testicle is one that moves back and forth between your childs groin and his scrotum. This condition typically subsides as your child ages. An ascending testicle is one that returns to your childs groin and cant be easily guided back.
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Low Testosterone And Aging
Testosterone production reaches its peak when a man is in his mid-20s. Fast forward to age 30, and men start losing about 1 percent of their testosterone annually. That slow decline means gradual changes, until a man reaches his 50s or 60s and those changes become obvious.
That does not mean every man of a certain age develops low testosterone, but it is a condition affecting between 20 and 25 percent of males in that age range.
How Is Testosterone Delivered In Trt
Testosterone replacement therapy can be administered in various ways:
- Transdermal testosterone skin patches: These are usually placed on your back, stomach, thighs, or upper arm. The patch slowly releases testosterone into your skin, where it is absorbed into your bloodstream.
- Topical testosterone gels: These gels contain testosterone, which is absorbed through the skin and into the bloodstream. When using testosterone gel, exercise caution because it can potentially spread to other people through close skin-to-skin contact, leading to mild side effects.
- Testosterone capsules: In some cases, your doctor may prescribe testosterone tablets or capsules. These frequently contain testosterone derivatives with a long half-life.
- Testosterone implants or testosterone pellets: These are placed beneath your skin. Most testosterone implants last 3-6 months before needing to be replaced.
- Intranasal testosterone: This is administered through the nose as a gel, allowing the testosterone to enter your bloodstream quickly.
- Testosterone injections: Your doctor may inject the medication in their office or instruct you on how to safely administer injectable testosterone at home.
Your doctor may ask you about your needs and preferences before recommending the best form of testosterone therapy for you. If you are uncomfortable with a particular type , inform your doctor so that they can prescribe a different form of testosterone.
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Could You Have Low Testosterone
Testosterone is a hormone made by the testicles. It is important for a man’s sex drive and physical appearance.
Certain health conditions, medicines, or injury can lead to low testosterone . Testosterone level also naturally drops with age. Low testosterone can affect sex drive, mood, and changes in muscle and fat.
Treatment with testosterone therapy may help reduce symptoms.
What Are The Risks Of Testosterone Therapy
A relatively small number of men experience immediate side effects of testosterone treatment, such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also watch out for high red blood cell counts, which could increase the risk of clotting.
Men on long-term using forms of testosterone therapy long term appear to have a higher risk of cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. For example, in 2010, researchers halted the Testosterone in Older Men study when early results showed that men on testosterone replacement therapy had noticeably more heart problems. “In older men, theoretical cardiac side effects become a little more immediate,” Dr. Pallais says.
Some physicians also have a lingering concern that testosterone therapy could stimulate the growth of prostate cancer cells. As with the hypothetical cardiac risks, the evidence is mixed. But because prostate cancer is so common, doctors tend to be leery of prescribing testosterone to men who may be at risk.
So, keep risks in mind when considering testosterone therapy or other therapies . “I frequently discourage it, particularly if the man has borderline levels,” Dr. Pallais says.
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Who Does Low Testosterone Affect
Male hypogonadism is a medical condition that can affect people with testicles at any age from birth through adulthood.
Low testosterone is more likely to affect people who:
There are several possible causes of low testosterone. The two types of male hypogonadism are:
- Primary hypogonadism .
- Secondary hypogonadism .
Causes of primary and secondary hypogonadism are also divided into either congenital or acquired .
Causes of primary male hypogonadism
Primary hypogonadism happens when something is wrong with your testicles that doesnt allow them to make normal levels of testosterone.
Another name for primary hypogonadism is hypergonadotropic hypogonadism. In this type, your pituitary gland produces more luteinizing hormone and follicle-stimulating hormone in response to low testosterone levels. The high levels of these hormones would normally tell your testicles to produce more testosterone and sperm. However, if you have damaged or missing testicles, they cant respond to the increased levels of gonadotropins. As a result, your testicles make too little or no testosterone and sperm.
Sometimes in primary hypogonadism testosterone levels are within the normal range and gonadotropins are high. Your specialist will help you understand if you need treatment, even with normal testosterone levels.
Congenital conditions that affect your testicles and can lead to primary hypogonadism include:
Acquired conditions that affect your testicles and can lead to primary hypogonadism include:
When Should I Start My Low Testosterone Treatment
Now that we hope you understand that you have nothing to fear from low testosterone treatment, you should see if you qualify for testosterone therapy as soon as possible.
Testosterone is vital to your strength, vitality, and wellbeing. However, you produce less testosterone the older you get! As your testosterone drops, so does your confidence and self-esteem. If you are looking for a way to replace what time and nature take away, the time to start low testosterone treatment is now!
The truth is, if you are a man over 40, and are feeling tired, depressed and less than a man, obtaining treatment for low testosterone can return joy to your life.
Make an appointment today, and get off of the downward spiral of fatigue, tiredness and sexual performance issues!
Take the first step to a younger, stronger, healthier, happy YOU!
You should see if you qualify for testosterone therapy as soon as possible. As with any medical condition, the sooner you start treatment, the better your outcome.
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Contact A Doctor To Discuss Options For Treating Low Testosterone
You do not have to accept the symptoms of low testosterone. If fatigue, loss of libido, weight gain, and other symptoms are negatively impacting your life, testosterone therapy may help. If you are experiencing low testosterone symptoms, or would like more information about testosterone therapy, call the offices of Dr. Edward Jacobson today and arrange a consultation.
How To Treat Low Testosterone Symptoms
As you get older, your hormone levels naturally change. For women, production of the primary female hormone estrogen drops in menopause, causing a range of physical changes.
For men, although the decline isnt quite so sudden or significant, its common for testosterone levels to gradually decrease over time.
If you think that you might have low testosterone, its best to bring this up with your healthcare provider or schedule an appointment with a urologist.
Theyll be able to check your testosterone levels, as well as your levels of luteinizing hormone , prolactin, hemoglobin and other related hormones, with a simple blood test.
If your total testosterone level is below 300 ng/dL, your healthcare provider may suggest using testosterone replacement therapy to increase your testosterone levels.
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