Testosterone Therapy for Hypogonadism Guideline Resources
Testosterone Therapy: What Men Need to Know About Low T and TRT Treatment Los Angeles Times
Good luck finding a supplement study that measured testosterone more than once at the beginning and once at the end of the study. "You can’t have a sensible conversation about testosterone," says Bradley Anawalt, chief of medicine at the University of Washington Medical Center. "Everybody thinks it’s going to make you stronger, faster, better looking, and better at sex. It doesn't do that." Here’s what "T-therapy" can do, how risky it is, and who might need it.
In the event these practices fail to raise a patient's testosterone levels naturally, Dr. Muthigi says he then introduces the idea of external testosterone supplementation, or testosterone replacement therapy (TRT). Lots of things can affect testosterone levels, including lifestyle factors like diet, sleep, stress and weight. Age can too, as the glands responsible for regulating testosterone decline over time, along with certain medical conditions like diabetes and genetic disorders. Although TRT offers benefits to people with low testosterone levels, it can cause many short-term side effects. Past research found a correlation between TRT and lower urinary tract symptoms (LUTS) due to testosterone’s growth-promoting effects on the prostate. This is common among aging men who developed hypogonadism late in their life. Recent clinical trials support this theory, concluding that although TRT may help in reducing prostate inflammation, it does not lower urinary tract symptoms and may even make these symptoms worse in the long term.
If you wonder whether testosterone therapy might be right for you, talk with your doctor about the risks and benefits. Most prostate cancers eventually stop responding to hormone therapy and become castration (or castrate) resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable.
However, you don't have to hit a certain number or level despite what the constant flow of ads may tell you. Clinicians must prescribe androgen replacement therapy using a risk-benefit assessment of the patient's clinical needs and risk of adverse reactions. There should be a clear, expected symptomatic benefit to justify continuing treatment beyond the initial clinical trial period of 3 to 6 months. They should employ shared decision-making techniques that include the patient, pharmacist, and nurses and set realistic goals as well as parameters for stopping therapy. "There is also a growing body of evidence that demonstrates testosterone is safe to administer in men with prostate cancer or previously treated prostate cancer," Dr. Muthigi adds. "However, this must be managed and monitored by an andrology specialist."
Ultimately, like most medications, testosterone therapy is not without risk. The known risks include a decrease in fertility and sperm count; elevated blood counts (polycythemia), which can lead to blood clots if not monitored properly; acne; breast enlargement; and hot flashes. A relatively small number of men experience immediate side effects of testosterone supplementation, such as acne, disturbed breathing while sleeping (worsening sleep apnea), breast swelling or tenderness, or swelling in the ankles. Doctors also watch out for free t4 lab test high red blood cell counts, which could increase the risk of clotting.
As men age, their hypothalamus and pituitary gland function gradually decline, leading to lower production of testosterone from the testes, according to Dr. Muthigi. In fact, there is always an age-related decline with testosterone, he says, but the rate differs in every man, depending on their genetics and lifestyle. Until they reach their 30s, most men have fairly constant levels of testosterone, which is controlled by a complex system involving the testicles, the hypothalamus and pituitary gland in your brain. A 2021 research study conducted on trans men using long-term TRT concluded that TRT caused an increase in red blood cell count. Red blood cell counts were taken from the individuals on a yearly basis and results showed an increase of 10% after the first year and 38% after 10 years.
Therefore, estradiol levels in men need to be assessed periodically to rule out hyperestrogenism. Testosterone gels and other external patches offer non-invasive ways to boost your testosterone, as the medication is absorbed through the skin barrier and into your bloodstream. However, it's important that the gel not come into contact with anyone else, as they might accidentally absorb it themselves. Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health, plus the latest advances in preventative medicine, diet and exercise, pain relief, blood pressure and cholesterol management, and more.
Doctors inject short-acting testosterone under the skin or into the muscle, while long-acting shots go in the gluteal muscles. This article will use the terms "male," "female," or both to refer to sex assigned at birth. But there aren’t many studies on the long-term effects of TRT (for example, over decades).
The concern, says Dr. Deibert, is overprescribing testosterone therapies for men that may not actually need therapy or prescribing additional therapies like estrogen blockers or human chorionic gonadotropin (hCG). "At most, just 5% of men who need testosterone therapy, will actually need these additional therapies," Dr. Deibert says. Testosterone deficiency is defined as testosterone blood levels less than 300 nanograms per deciliter (ng/dL). Study design is one of the most important aspects of any investigation because it defines the reliability of outcomes and the extent to which they may be extrapolated to other groups. Meta-analyses of RCTs and cohort studies provide the highest levels of evidence and reliability, followed by individual RCTs, prospective cohorts, retrospective cohorts, and observational studies. Clinicians should understand that of these agents, only hCG has been approved by the FDA for use in males, specifically to treat males with hypogonadotropic hypogonadism.
By clicking REVIEW MY CASE, you agree to our privacy policy and disclaimer. After submitting, you will be contacted by one or more of Drugwatch's trusted legal partners (including autodialed and prerecorded calls or text/SMS messages). Your consent to text messaging is not required for a case review and you may opt out of text messages at any time by texting STOP. First approved in 1979, Depo-testosterone is one of the older drugs of its kind on the market. It’s a liquid designed for injection deep into the gluteal muscle. Testosterone, as a Schedule III drug, is available only with a prescription.
