Testosterone Replacement:
Testosterone is a hormone made by the testes and the adrenal gland that has many effects throughout the body. Men usually have more testosterone than women which have less of this hormone when both sexes are young . However when men and women get older their testosterone levels decrease. Women may have higher testosterone levels when they age. Women with polycystic ovarian syndrome have higher testosterone levels than normal women.
Testosterone is important for muscle mass, bone strength, hair growth and sexual function. Low testosterone can cause poor concentration, low energy, depression, low libido and erectile dysfunction. Testosterone deficiency is common affecting 7% of men in their 50s. This deficiency increases with age. As men age their muscle mass decreases and their fat level is increased due to the lower levels of testosterone. Bellies of older men also become bigger
Causes of Testosterone Deficiency:
One reason is that the testes are not working properly. The other is that the brain is not producing a hormone that tells the testes to make testosterone. Infections, trauma, exposure to toxins, diabetes, obesity, anemia and HIV infection may all cause low testosterone levels. Medications like opiates and steroids can also lead to deficiency of this hormone.
Testing for Testosterone Deficiency:
A complete physical and blood tests in the morning are necessary to confirm the diagnosis. It is important to remember to test testosterone level early in the morning.
Treatment for Testosterone Deficiency:
Treatment comes in topical gels, injections and pellets under the skin. Men taking this therapy should consult their physicians regularly. Side effects of this therapy include headache, hair growth in the body, male pattern baldness and acne.
It is important to check the blood levels of testosterone to make sure they are not too high. Hemoglobin check is also a necessity as it may increase when the testosterone level is high. Also the estrogen levels should be low in men to prevent the aromatization of testosterone to estrogen. If this occurs, a few weeks of no testosterone replacement is the best solution. Sometimes we need to remove some blood to decrease the hemoglobin level.
Women also take testosterone to increase bone mass and libido. The dosage is lower in women.
There is no evidence that testosterone increases the risk of blood clots. Though testosterone affects the prostate, there is no link between prostate cancer and testosterone replacement. To be safe though, men treated with prostate cancer should not get testosterone replacement.
We also need to check estrogen levels so as to prevent the formation of estrogen from testosterone, there are medications that prevent this formation. Older men have bigger breasts due to the conversion of estrogen from testosterone. These men have also lower libido.
Some women have testosterone in their postmenopausal creams to improve their libido as well
Finally it was proven that testosterone is not linked to strokes and heart attacks.
Schedule of the injectables;
Once it is shown twice that the patient has low testosterone, we give a testosterone injection every week for about a month. We individualize the program to each person to obtain the best program for everybody. .We use in the office mainly injections of testosterone cypionate which are well tolerated. We are afraid that gels can be transferred to the skin of spouses, children and pets. The pellet insertion is more invasive and needs frequent blood work ups.The advantage of the pellet insertion is that the person does not need to do injections as the hormone is slowly released in the bloodstream during one to two months. Some people like that convenience. Most of our patients prefer the injections.