Low Testosterone (Low T)

Low testosterone is a common condition that often goes undiagnosed because its symptoms are similar to other conditions. For some time, we were not attributing these symptoms to low testosterone, but to diabetes, depression, high blood pressure, and coronary artery disease. Recently public awareness and appreciation of low testosterone has increased. We recognize now that low testosterone may be at the root of many of these problems.

Hormonal Optimization

Many patients that have symptoms of low testosterone just have an imbalance of other substances that affects the performance of testosterone. Patients can lack the proper signaling hormones, too much conversion to estrogen or lack of the substances their body uses to create or utilize testosterone. We do a thorough check of all these hormones and work with the patient to make a plan to help them feel better.

Running Low on Fuel?

The symptoms of low testosterone can include diminished interest in sex, erectile dysfunction (ED), reduced lean body mass, depressed mood, poor sleep, and lack of energy. If you are experiencing diminished interest in sex, ED or multiple symptoms together such as lack of desire to have sex and lack of energy you should talk to your doctor.

Diagnosis

Low testosterone can be easily identified and treated. As a starting point, take the Androgen Deficiency in the Aging Male (ADAM) questionnaire below. This may be helpful in assessing your likelihood of having low testosterone. Your physician can check your testosterone levels with a simple blood test. If you do have low testosterone your physician can easily treat it. There are several treatment options available such as gels, patches or injections that increase the amount of testosterone in your body.

Take the Quiz

If you are experiencing a lack of interest or desire in sexual activity, take the ADAM questionnaire and share it with your doctor. If you answer yes to questions 1 or 7 or any 3 other questions, you may have low testosterone and you should see your doctor.

Do you have a decrease in libido (sex drive)?
Do you have a lack of energy?
Do you have a decrease in strength and/or endurance?
Have you lost height?
Have you noticed a decrease in your enjoyment of life?
Are you sad and/or grumpy?
Are your erections less strong?
Have you noticed a recent deterioration in your ability to play sports?
Are you falling asleep after dinner?
Has there been a recent deterioration in your work performance?

What testosterone replacement therapy options are available?

Oral Testosterone:

Historically we have avoided this because of liver damage but a new medication was FDA approved in 2019 which avoids liver issues. This has been difficult to get covered by insurance companies.

Gels and Solutions:

Testosterone gels and solutions are applied daily. The testosterone in the gel or solution is absorbed into the body through the skin. They provide continuous delivery of testosterone throughout the day. It's important to make sure that other people are not exposed to the gel or solution. This typically occurs when skin-to-skin contact is made with the application site.

Patches:

Patches allow testosterone to be absorbed by the skin. Patches are applied daily.

Injections:

Testosterone injections, usually in the upper buttock, are typically given every 1-2 weeks by your doctor.

Buccal Tablet:

In your mouth, the tablet is applied to the gum, where testosterone is absorbed over a 12-hour period.

Nasal Applicator:

There is a name brand testosterone nasal applicator that has to be used 2-3 times a day. Some patients find it irritating but it may decrease the negative effects on blood count and fertility that you can see with other treatments.

Pellets:

Pellets are placed under the skin near the hip by a doctor during a surgical procedure. Occasionally these are covered by insurance but often insurance companies limit the number of pellets covered leaving the patient a lower level than desired. Occasionally patients want to pay for this treatment outside of insurance to get the levels desired.

Each of these treatment options can help men with Low T achieve adequate levels of hormone replacement. Some men have more complex issues including poor function of hypothalamus or pituitary gland or elevated estrogen or sex hormone binding globulin (SHBG). These require more extensive testing, but treatments are available.