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Testosterone Replacement Therapy Florida

Low Testosterone, What is It?

Before we answer the question of what is low testosterone, lets discuss what testosterone is. It can be stated that testosterone is the hormone that characterizes men. Although women have testosterone, men produce much more. In men, testosterone is responsible for a deeper voice, body and facial hair and greater muscle mass. Moreover, testosterone is responsible for genital growth during puberty, sperm production, driving libido and promotes normal healthy erections. Furthermore, testosterone furthers red blood cell production, enhances cognition and improves mood.

Low testosterone or “Low-T,” results when the body’s level of the hormone testosterone declines below the medically acceptable optimal range for a healthy person. This process of declining testosterone is commonly referred to as andropause. Andropause normally occurs in all men as they age, after the age of thirty. However, there are other reasons for low testosterone including but not limited to stress, alcohol and drug use, chronic illness, being overweight and the use of certain prescription drugs.

Testosterone Replacement Therapy Florida

As men age, the testicular mechanism responsible for making testosterone becomes progressively less effective, whereby testosterone levels begin to decline, by about 1% a year, usually around their 30’s and 40’s. By the time men get into their 50’s, they may begin to notice symptoms that are associated with low testosterone including lower sex drive, decrease in energy, lower sense of vigor, decrease in muscle mass and bone density, erectile dysfunction, and even anemia. As a totality, these symptoms associated with low testosterone are commonly referred to as hypogonadism, which means a lessened function of the testicles. Medical researchers in the United States claim that low-t affects anywhere from three to seven million men. Unfortunately, this condition remains severely underdiagnosed, with only about 5-10% of men affected who receive treatment.

Recent studies have revealed that treatments such as Testosterone Replacement Therapy or TRT might offer a comprehensive range of benefits for men suffering from hypogonadism, including improved mood, vitality, libido, bone density, cognitive function, muscle mass, and production of red blood cells. However, there is a wide range of disagreement in the medical community as to what range constitutes low testosterone, whether testosterone supplementation should be used and what potential risks might the patient experience.

Testosterone Replacement Therapy Florida

Most Common Indicators of Low Testosterone In Men

Generally, the most common complaints associated with lower testosterone is a decrease in libido, sexual desire and/or erectile dysfunction. Most doctors say that when a patient complains about erectile dysfunction, they advise the patient to get his testosterone levels checked. Additionally, some men experience different symptoms which may include, trouble having an orgasm, lower fluid amount during ejaculation, a numbing feeling in the penis rather than arousing and lower intensity orgasms. The greater number of symptoms that are experienced, the higher the probability that low testosterone is the culprit of the issue.

Testosterone Replacement Therapy Florida

Too many physicians have a propensity of dismissing some of the aforementioned symptoms and tell their patients that this is part of the aging process. This is an unfortunate situation, since many of these symptoms can be reversed by the normalization of testosterone levels with hormone replacement therapy and drastically improve the quality of life of the patient.

Although the effects of low testosterone are often associated with problems concerning sexual health in men, continuing to live with low testosterone can be draining on your overall health and well-being. The following is are additional symptoms associated with Low-T:

  • Decrease in strength and muscle tone
  • Increased in stored bodyfat, particularly around the midsection
  • Loss of energy and increased feeling of lethargy
  • Loss and depletion of motivation
  • Brain fog, difficulty focusing and loss of mental clarity
  • Greater experience of fatigue, feeling tired, shortly after starting the day
  • Interrupted sleep cycles
  • Depression, increase in mood swings and irritability
  • Decreased sense of feeling healthy

What You Can Expect After Testosterone Replacement Therapy

  • Increase in mental clarity
  • Increase in energy and vitality
  • Increase in lean muscle
  • Decrease in body fat
  • Decrease in waist circumference
  • Restored sexual function including an increase in libido, desire and erections
  • Lesser cholesterol levels and lower risk for heart disease
  • Improved general sense of well-being and greater feelings of motivation
  • Decrease blood sugar

Are You A Candidate for Testosterone Replacement Therapy?

Determining whether you are a candidate for Testosterone Replacement Therapy is determined by performing a blood test and the symptoms that the patient has experienced. Usually men with lower testosterone have more of the symptoms that we discussed above while men with higher testosterone have less. However, in some cases, while a blood test may reveal low testosterone, there are no symptoms present.

If we are going strictly by the numbers, a total testosterone level which is below 300 ng/dl is medically considered low testosterone. This standard has been established by The Endocrine Society, who publishes recommendations and guidelines for clinical practice.

Speaking of total testosterone, not all testosterone in the body is available to the cells, approximately half of the testosterone in the body is bound to a sex hormone binding globulin which is commonly referred to as SHBG. Free testosterone is the biologically available part of total testosterone, and is the one that is accessible to the cells. Most blood tests will measure free testosterone, which is a strong indicator of Low-T.

Factors That Affect Testosterone Levels

Generally, men over the age of 40, have a 7-12% decline in their testosterone levels after mid-afternoon, which is why blood tests to check testosterone levels are administered in the mornings. Additionally, men who consume a high protein diet have higher testosterone levels.

Difference Between Endogenous And Exogenous Testosterone

Exogenous testosterone refers to testosterone that is manufactured outside the body, which is often used in TRT to treat hypogonadism. Typically exogenous testosterone is administered via injection. Endogenous testosterone differs because it is produced by the body. Recent research of clomiphene citrate, also known by its trade name as Clomid, which is generally prescribed to women with infertility problems in order to stimulate ovulation has shown some interesting results by increasing testosterone levels in men endogenously. The recent off-label study, clomiphene citrate was administered daily to a group of men with low testosterone for a period of three months. Half way through the study it was discovered that all of the subjects had increased their testosterone levels with no side effects reported even a year after the study had been concluded.

Available Types of Preparations in Testosterone Replacement Therapy

The first type of type of testosterone preparation which is used in TRT is a topical gel, which can be administered by the patient themselves. Androgel and Testim, are the two most commonly prescribed topical testosterone gels in the United States. The gel is dispensed from a tube and is rubbed into the upper arms and/or shoulders once per day. While this method is convenient, the absorption of the gel for some patients is so poor that it will not yield enough testosterone to have the desired effect. Another topical type used in TRT is a patch, however this method has a very high incidence of skin irritation in almost half of its users.

The second type of testosterone preparation used in TRT and the most reliable in getting results is an injectable. Absorption is not an issue as with the gel, and shots can either be administered at our office or by the patient depending on their knowledge and comfort level. The frequency of injections runs between once per week or once every two weeks.

Are Testosterone Pills Safe?

Although there are testosterone pills in the Unites States, their use is highly discouraged due to the toxicity they cause in the liver. However, an oral formula called testosterone undecanoate has been prescribed in Europe and Canada for the last decade and is considered relatively safe. The use of testosterone undecanoate was submitted to the FDA and was approved in 2014 in an injectable form, while the oral (capsule/tablet) version is pending approval.

One of the advantages of testosterone undecanoate is that as an injectable, its effects last for 3 months. Therefore, if a patient was using it throughout the year, he would only need 4 injections annually. Testosterone undecanoate is sold under these name brands; Andriol, Aveed and Nebido.

Testosterone Replacement Therapy Benefits for Cognition

There have been several studies that examined whether there was an improvement in cognition as a result from TRT. In one of the studies, the results showed that there was a significant improvement in cognitive function in men with testosterone deficiency syndrome where Low-T was related to cognitive impairment and depression.

What Are The Risks Considered in Testosterone Replacement Therapy?

Potential patients who are considering testosterone replacement therapy are naturally concerned about risks with treatment. Patients need to keep in mind that their bodies already produce testosterone. The testosterone molecule that is administered is the same as the one that the body produces naturally. The primary of goal of testosterone replacement therapy is to bring back the patients concentration of testosterone to a level that they had 10 to 20 years prior.

In some cases patients may be advised to proceed with caution if certain health conditions exist, which is why a complete blood panel is done prior to administering any testosterone. As an example, testosterone may increase hematocrit, which is the ration of red blood cells in the bloodstream. In the event that the hematocrit rises, there may be potential for the blood’s viscosity to change, making it thicker and prompting the possibility of stroke and or blood clots. However, this is only theoretical and there are almost no cases where medically supervised testosterone replacement therapy caused stroke or serious clotting in a patient in the United States.

Moreover, in rare cases medical professionals are hesitant in prescribing testosterone to patients with compromised liver function, weak kidneys, and/or any type of congestive heart failure. Testosterone may also case an increase oil that is produced by the skin which may result in acne, but this is in rare cases as is gynecomastia (an enlargement of the breast) and/or sleep apnea.