Testosterone Replacement

Testosterone is the hormone that is responsible for male sexual development, as well maintaining muscle mass, sufficient red blood cell levels, bone growth, skin integrity, mental focus and well being, and of course, sexual function. When this hormone, which is produced in the testicles, decreases more than is normal (testosterone levels naturally decrease after age 30), erectile dysfunction can occur. Is testosterone replacement therapy a viable choice for you?

Only after a thorough prostate exam can this question be answered, but in general, most men with low testosterone levels can benefit from testosterone replacement. Those with a history of prostate cancer should be treated with caution and close supervision. Testosterone is not believed to cause prostate cancer but it may allow it to grow if it is already present. Testosterone is not indicated for men with a history of breast cancer. Without a medical test, there is no way to know if you have a testosterone deficiency, but you will likely experience the following symptoms:

  • Loss of sex drive.
  • Erectile dysfunction.
  • Inability to concentrate.
  • Depression.

Eventually, changes in the body may present, including:

  • Decreased muscle mass.
  • Increased body fat.
  • Changes in cholesterol and lipid levels.
  • Mild anemia
  • Decreased body hair.
  • Fragile bones.

Inadequate testosterone levels may be caused by injury to the testicles, illness, certain medications, stress, alcoholism, and congenital disorders. If you suspect that you may have a testosterone imbalance, see Dr. Spitz so you can get a proper diagnosis and begin to take steps to treat it.

Testosterone patches. These are medicated patches that are applied every 24 hours and which release testosterone into the body in a controlled manner. There are patches that you place on your back, stomach, upper arms, or thighs, but there are also patches designed to be applied to the scrotum, which may absorb testosterone more effectively. In any case, make sure you place the patches in the correct location.
Testosterone gel/ointment. These preparations work like the patches and are applied daily on the back, shoulders, or on the stomach, depending on the formulation. They may be prescribed as nationally available brands such as Androgel or Testim or they may be dispensed from a compounding pharmacy.

Injections. Injections are given every one to two weeks in the buttocks or thigh. Dr Spitz’s office can provide the injections or his nurses can teach you to perform the injections yourself. Although the idea of an injection may be concerning, the convenience of less frequent dosing appeals to many men. Some men fail to achieve therapeutic doses with gels or patches and require injections.

Implants: Testosterone pellets can be implanted in the buttocks with a minor surgical procedure. These pellets will last several months before new pellets need to be implanted. The recoverey is typically a day or two with some minor bruising possible at the area of insertion.

Oral medications. Testosterone pills are not prescribed to treat low testosterone levels because they present a risk of liver abnormalities. Other pills that help the body increase its own testosterone production may be prescribed in certain circumstances such as part of a treatment regimen for male infertility. These medications include clomiphene citrate which boosts the pituitary stimulation of the testicle’s production of testosterone. Another medication is Arimidex which blocks the conversion of testosterone to estradiol.

Side Effects. Testosterone is by and large a very safe and effective medication with few and infrequent side effects. The most significant effect testosterone has is that it shuts down a mans own production of testosterone while he is getting testosterone replacement treatment. This results in a decline and eventual stopping of his sperm production. This is reversible for about 90 percent of men who receive testosterone replacement therapy at normal healthy levels.. It may take 6 months to a year for these men to get back to their starting levels. Men who abuse testosterone and use very high doses are at much higher risk of never rebounding back. Testosterone replacement is usually intended for long term use so most men do not intend on stopping the therapy. Other side effects include acne but this is typically when the level of testosterone is near or above the upper limit of the normal range. Agitation may occur as well. For men with sleep apnea, this condition can be aggravated because the voice box enlarges slightly. Men with sleep apnea are relieved with proper treatment for this condition. If untreated sleep apnea may cause the blood count to increase so as to make the blood “thick” and present a risk of stroke. This is very uncommon. Additionally, testosterone may cause this blood thickening even without sleep apnea but this is rare and resolves with dose adjustment. High levels of testosterone can cause nipple tenderness or even gynecomastia. Testosterone may cause slight enlargement of the prostate which can cause some difficulty urinating in a very small percentage of men. It also can cause prostate cancer to grow, but only if the cancer is already present. It does not cause prostate cancer. It should be avoided in men with breast cancer history.