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Testosterone is a hormone produced by a man's testicles. As men age testosterone levels can decrease. A decrease of testosterone can also occur due to other medical problems like obesity and diabetes. Low testosterone levels are found in 40% of men over the age of 45. Low Testosterone is a condition called hypogonadism. Low levels of testosterone can affect a man in different ways.

Common Symptoms

  • Decreased libido (sex drive)
  • Decreased energy level
  • Loss of muscle mass
  • Increased abdominal fat
  • Difficulty concentrating
  • Problems with erections
  • Infertility

How is low testosterone diagnosed?

Upon initial evaluation a thorough history of symptoms is obtained as well as a physical examination to rule out any medical causes that may need further treatment.

Low testosterone levels are determined using a blood test. Your doctor may need to get more than one testosterone level in order to determine your true hormone status.


What are the options for treatment of low testosterone?

There are several options for treatment of low testosterone. You and your physician can decide which is best for you.


Topical Applications

  • Gels: These are preparations that are applied to the skin daily.
  • Testosterone is absorbed directly through the skin. They are easy to use and well tolerated by many patients. Examples of these include:

Injections

There are several forms of injectable testosterone available. Using a needle, testosterone is injected directly into a large muscle group and absorbed by the body. This can be done in the office or you can be taught how to give yourself an injection at home. Typical preparation for injection include:
  • Testosterone cypionate
  • Testosterone enanthate

Subcutaneous Pellets

Tesel is a testosterone pellet that can be inserted under the skin in the doctor's office. Once in place the pellet starts to dissolve and release testosterone. The pellets cannot be seen or felt once in place. This procedure is done about every three months. This is a good option for patients that do not want to worry about daily or weekly administration.


How is testosterone therapy monitored?

Once you are started on testosterone, you will need periodic monitoring. In most cases testosterone levels will need to be checked about a month after starting treatment. After you are stable on treatment, blood levels of testosterone, red blood cell count, and cholesterol levels will need to be checked approximately every six months.

  • Infertility
  • Worsening prostate symptoms
  • Excess red blood cell count
  • Breast tenderness
  • Worsening breast cancer if present

What about the risk of prostate cancer?

Currently there are no scientific studies that show a link between prostate cancer and testosterone replacement therapy. If you have untreated prostate cancer, most physicians would recommend against starting treatment with testosterone. If you are concerned about prostate cancer this should be discussed with your doctor and an individual risk assessment can be performed.