OVERVIEW
Low testosterone, also known as hypogonadism, is a condition in which a man’s testosterone is below the normal reference range of the laboratory. The treatment of low testosterone is based not only upon blood work, but also upon appropriate symptoms. At times, testosterone levels may be adjusted by age.
Symptoms
Symptoms of low testosterone vary significantly and are generally not specific only to low testosterone levels.. You may experience the following common symptoms:
- Decreased sex drive (libido)
- Poor sexual performance (Conversely, men with low testosterone may not have sexual performance problems)
- Low energy/Fatigue
- Decreased exercise tolerance
- Low bone density
Causes
Low testosterone is typically divided into two categories - primary and secondary.
- Primary refers to a problem whereby the testicle itself cannot produce enough testosterone.
- Secondary refers to a problem with the pituitary gland whereby appropriate signals are not sent to the testicle in order to produce testosterone.
Many men with low testosterone have neither a primary or secondary cause. In many of these men, low testosterone is simply related to poor overall general health. Men with obesity, high cholesterol, high blood pressure and diabetes are particularly at risk. Chronic opiate (narcotics) use may contribute to a low testosterone level. Patients who have used anabolic steroids may develop testosterone production problems.
Diagnosis/Evaluation
- What to know before your visit:
- The doctor will take a complete history regarding sex drive (libido), sexual performance problems, previous treatments, and overall general health. Particularly, a history of diabetes, obesity, opiate use and anabolic steroid use will be discussed. Physical examination will focus on the testicles and overall body appearance. It is important to bring any prior testing to the office visit.
- Other tests that may be performed during or after your visit:
- Labs: Typically, a screening testosterone level has been ordered by the primary care physician. Additional testing may include repeating the testosterone level and obtaining additional testing such as free testosterone, prolactin, and luteinizing hormone. At times, a sex hormone binding globulin may be obtained.
Treatment
NON-SURGICAL TREATMENT
In appropriate patients, treatment of low testosterone may be indicated either with testosterone replacement therapy or medications that may be used to treat pituitary gland problems.
- Oral therapy: Currently, there is only one FDA approved oral testosterone (Jatenzo®) medication, which was approved in 2019. Only patients with certain underlying medical conditions will be candidates for this medication.
- Topical gels (Androgel® or Testim®)
- Generic Intramuscular injections
- Long-acting intramuscular testosterone injections (Aveed®)
- Subcutaneous testosterone injection (Xyosted®)
- Subcutaneous testosterone implants (Testopel®)
- Nasal gel (Natesto®)
- Buccal musocal (under the gums) medication (Striant®)
SURGICAL TREATMENT
There are no surgical treatments or low testosterone except in rare instances when a pituitary tumor may be diagnosed.
Schedule an appointment with a MidLantic Urology physician near you today!