Testosterone Replacement Therapy

Testosterone is a vital hormone in men, responsible for initiating and driving the development of male secondary sexual characteristics during puberty—such as facial hair growth, voice deepening, and reproductive function. As men age, testosterone levels naturally decline in a process known as andropause or late-onset hypogonadism.

While idiopathic hypogonadism (low testosterone without a known cause) is most commonly diagnosed in men in their 50s and 60s, younger men can also experience low testosterone and related symptoms. 

Symptoms of Testosterone Deficiency May Include:

  • Reduced libido or sexual interest
  • Difficulty achieving or maintaining erections
  • Low energy or fatigue
  • Decreased muscle mass and strength
  • Reduced bone density
  • Depressive symptoms

Testosterone Replacement Therapy (TRT)

TRT is an FDA-approved treatment option for men diagnosed with hypogonadism. Several delivery methods are available:

  • Injectable Testosterone: Administered intramuscularly or subcutaneously. Some formulations can be self-injected at home, while long-acting versions may require administration by a healthcare provider.
  • Testosterone Pellet Therapy: Involves a small incision to insert pellets into the gluteal fat tissue. These pellets release testosterone steadily over about three months and are ideal for those who prefer to avoid frequent injections.
  • Topical Gels and Creams: Applied daily to areas like the outer arms, abdomen, or inner thighs. However, due to the risk of transference to others, alternative methods may be recommended in certain cases.
  • Oral Testosterone: Newer formulations are processed through the lymphatic system, avoiding liver damage associated with older versions. Typically taken twice daily, this option is suitable for those who prefer to avoid needles.
  • Your healthcare provider will help determine the most appropriate method based on your needs and preferences.

Monitoring and Side Effects

There are several physiologic side effects that should be closely monitored while a patient is on testosterone therapy, these include:

  • Blood pressure changes
  • Hematocrit levels (red blood cell concentration)
  • Cholesterol levels
  • Prostate health
  • Blood testosterone levels

Possible Side Effects Include:

  • Acne or oily skin
  • Hair loss
  • Mood changes
  • Reduced sperm count, potentially leading to infertility
  • Skin irritation (especially with topical applications)