Low Testosterone Atrium Health Wake Forest Baptist

Testosterone Therapy: Review of Clinical Applications

If you have signs and symptoms of low testosterone, a healthcare provider will perform a physical exam. They’ll also ask questions about your medical history, medications you take or have taken, smoking history and any symptoms you currently have. Any issue with your testicles, hypothalamus or pituitary gland can cause low testosterone (male hypogonadism). The U.S. Food and Drug Administration clarified in 2015 that prescribing testosterone for low testosterone levels due to aging constitutes off-label use.

Children with intersex conditions (development of both male and female reproductive organs) may also have trouble with testosterone production. When low testosterone is accompanied by other symptoms, like low sex drive, fatigue, and moodiness, urologists make a diagnosis of testosterone deficiency (TD). Other symptoms may include insomnia, weight gain, reduced muscle mass and strength, heart problems, osteoporosis and difficulty concentrating. The problem is that many of these same symptoms can also be signs of other health issues.

Your specialist will help you understand if you need treatment, even with normal testosterone levels. Sometimes referred to as “andropause,” low testosterone levels are often compared to menopause in women. However, in menopause there is a complete estrogen deficiency causing known clinical side effects. Men have decreased levels of their sex hormone with less obvious clinical consequences.

The hormone seeps through the skin, and is slowly released into the blood. Because gels and patches are applied every day, they keep a steady level of testosterone. However, they can cause itching, irritation, and blisters at the spot where they’re applied. Women and children should not touch skin treated with a gel or patch. If you have an illness known to lower testosterone, your doctor may want to test your levels of the hormone. When levels of the hormone are low, their sperm “count” can be low, too.

Your doctor can check for testosterone imbalances and help you fix them so that these signs and symptoms go away. Before your test, your doctor may tell you to stop taking some drugs that could affect your testosterone levels. You should also tell your physician about all the medicines you are taking. Testosterone helps build new bones and keep the mass you already have.

Low testosterone levels may lead to an increase in body fat mass. Research suggests that up to 35% of men with erectile dysfunction have low T. However, research is inconclusive on whether testosterone replacement therapy could successfully treat erectile dysfunction. It is possible to have low levels and not experience symptoms.

Similarly, in the event patients have unexplained anemia that improves on testosterone therapy, continuation can be considered even in the absence of other symptom improvement. For patients on daily medication, the Panel recommends that patients use medication the day of follow-up blood work. Patients on topical gels, patches, and intranasal formulations should have their testosterone checked between two to four weeks after commencement of therapy. Although steady-state levels are generally reached within days following commencement, a longer interval takes into account the potential decreases in endogenous testosterone production when on exogenous testosterone. For adults in general, behavior-based interventions have been found to be safe and effective. However, the literature at this time fails to define the LH level below which such adjunctive testing is warranted. In the event that a patient may have hypogonadotropic hypogonadism, adjunctive tests should be ordered.

These agents share the common overall treatment effect of increasing intrinsic production of testosterone, but there are substantial differences in pharmacologic characteristics and mechanisms of action between them. Given these pharmacologic and mechanistic differences, combinations of these alternative therapies might, in some instances, be clinically appropriate. Other population-based studies have attempted to measure prevalence, but have not used standard methodology, which makes arriving at a definitive number of testosterone deficiency difficult. Where gaps in the evidence existed, the Panel provides guidance in the form of Clinical Principles or Expert Opinion with consensus achieved using a modified Delphi technique if differences of opinion emerged.

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