Testosterone Therapy for Men

Revive Low T Clinic specializes in the diagnosis of low testosterone in men and low testosterone therapy and treatments.

Men with low testosterone may notice a number of symptoms:

• Fatigue
• Decreased motivation/drive
• Decreased mental clarity
• Increased body fat
• Decreased libido
• Decreased muscle mass
• Irritability

Some men may notice difficulty getting and maintaining erections or a decrease in night time erections (morning wood). Other men may notice reduced beard and body hair. You can even feel like you’re going through menopause with hot flashes and mood swings.

In this article we will discuss the causes of low testosterone, different types of testosterone therapy, and potential benefits and side effects of testosterone therapy in men.

Causes of Low Testosterone

Low testosterone in men is also known as male hypogonadism, which means the testicles don’t produce enough of the male sex hormone testosterone.

There are two basic types of hypogonadism:

1. Primary Hypogonadism
• This type of low testosterone — also known as primary testicular failure — originates from a problem in the testicles.
2. Secondary Hypogonadism
• This type of low testosterone indicates a problem in the parts of the brain that control the signal sent to the testicles to produce testosterone. Luteinizing hormone (LH) is the message sent from the brain through your blood to the testes that signals them to produce testosterone.

Either type of hypogonadism may be caused by an inherited (congenital or genetic) trait or something that happens later in life (acquired), such as an injury or an infection. At times, primary and secondary hypogonadism can occur together. Often it can be difficult to identify the specific cause of low testosterone.

There are a number of potential causes of low testosterone and our doctors can assist you with lab testing and referrals to specialists for further testing as needed.

Trying to find the cause of your low testosterone can be important because that will help determine what type of testosterone therapy will be most effective. It can also help us focus in on any other medical issues we may need to be concerned about, such as diabetes.

Primary Hypogonadism

Common causes of primary hypogonadism include:

• Klinefelter syndrome
• Men with this congenital abnormality of the sex chromosomes, X and Y are born with it. A male normally has one X and one Y chromosome. In Klinefelter syndrome, two or more X chromosomes are present in addition to one Y chromosome. Having an extra X chromosome causes abnormal development of the testicles, which leads to low testosterone.
• Undescended testicles
• The testicles start higher up and move down prior to birth. If one or both of the testicles are not descended before birth it may lead to reduced function of the testicles and low testosterone.
• Mumps orchitis
• Infection of the testicles can occur in children and adults. This may cause permanent damage of the testicles and low testosterone.
• Hemochromatosis
• Too much iron in the blood can cause testicular failure or reduced function of the pituitary gland. This can cause low testosterone.
• Injury to the testicles
• The testicles are prone to injury as they are less protected than other organs. Damage to the testicles can cause low testosterone.
• Cancer treatment
• Chemotherapy or radiation treatments for cancer can interfere with testicular function causing low testosterone and reduced fertility. The effects of chemotherapy and radiation of fertility and sperm can be temporary or permanent.
• Normal aging
• Aging may cause low testosterone. Testosterone levels tend to decline with age.

Secondary Hypogonadism

In secondary hypogonadism, the testicles are normal but still don’t produce enough testosterone because not enough signal is being sent from the brain (pituitary and hypothalamus).

A number of conditions can cause secondary hypogonadism, including:

• Kallmann syndrome
• Abnormal development of the hypothalamus can cause problems with signals produced in the brain that tell the testicles to make testosterone. Men with this syndrome may also have reduced ability to smell (anosmia) and red-green color blindness.
• Pituitary disorders
• An abnormality in the pituitary gland can impair the release of signals from the brain to the testicles, causing low testosterone. This can be caused by a tumor in that area of the brain. Also, the treatment for a brain tumor (ie surgery or radiation therapy) may cause reduced signal production and low testosterone.
• Inflammatory disease
• Some diseases like sarcoidosis, histiocytosis and tuberculosis, can reduce the signals sent from the brain to the testicles. This can cause low testosterone.
• HIV/AIDS
• HIV/AIDS can cause low testosterone by reducing the signals sent to the testicles from the brain.
• Medications and Recreational Drugs
• Both recreational and prescription drugs, such as opiates and prednisone, can cause low testosterone.
• Obesity
• Obesity may cause low testosterone and testosterone therapy may help with weight loss.
• Normal aging
• Aging may cause low testosterone. Testosterone levels tend to decline with age.
• Stress-induced Hypogonadism
• Extreme stress, illness, and injury can cause low testosterone. Testosterone levels may increase with recovery.

More About Secondary Hypogonadism

The parts of the brain that controls the signal from the brain to the testicles are hypothalamus and pituitary glands. The brain “tastes” circulating hormone levels in the blood and reduces the signals or increases the signals accordingly to control hormone production in other parts of the body (ie testicles).

In secondary hypogonadism, where there is a lack of signal being sent from the brain to the testicles, we often see plenty of estrogen on lab testing.

In some men, if we can reduce the conversion of testosterone to estrogen we can increase the production of testosterone.

Diagnosing Low Testosterone in Men

Many men have their testosterone levels checked by their primary care doctors and are told “you’re normal.” Often primary care doctors only check total testosterone levels but in many men, especially older men, this causes them to miss something very important – free testosterone.

Total testosterone is the total amount of testosterone in your blood but most of this testosterone is inactive. At Revive Low T Clinic we have found a way to check total and free testosterone so that many patients who were previously diagnosed as “normal” despite having many symptoms, are actually quite low in free testosterone.

Some doctors try to measure free testosterone directly via a lab test but because it is such as small amount to measure the test is less accurate.

The more accurate way to assess free testosterone is by measuring what binds the testosterone making it inactive, sex hormone binding globulin, and doing a calculation. Also, calculated free testosterone tends to be more in line with a patient’s symptoms and is, generally, more cost-effective.

Testosterone Therapy Options

What if I am diagnosed with low testosterone?

It is always good to let your primary care doctor know about any new diagnosis you have or treatments you are doing. We recommend you discuss any diagnosis your Revive Low T Clinic doctor makes with your primary care doctor as they may have other ideas or concerns. For example, brain tumors are rare but perhaps your primary care doctor will want to refer you for an MRI scan to be on the safe side.

Most of our patients with low testosterone do weekly testosterone injections at our clinic or at home. We will also discuss other low testosterone therapy options such as HCG injections.

Testosterone Injections

The majority of our patients diagnosed with low testosterone do weekly testosterone injections. The medication used for the testosterone injections is testosterone cypionate. This medication is available at a variety of pharmacies and we are happy to help you find the most cost effective option.

Some of our patients choose to come to our clinics to receive their testosterone injections while others do their testosterone injections at home. With good technique, testosterone injections rarely cause significant pain and are, in our opinion, one of the most effective and safest low testosterone therapy options.

Topical Testosterone

Some men wish to try topical testosterone and that is a low testosterone therapy option we offer at our clinic. Topical testosterone is applied daily to the skin.

There are a number of problems related to topical testosterone:

1. It can easily be transferred to others and can cause women to get little mustaches and worse, etc.
2. We have found it to be less effective than testosterone injections based on patient results and experiences
3. You have to do it every day (vs once a week with testosterone injections
4. And other issues which we are happy to discuss with at your visit

With all that being said, some of our patients like to use it while they are traveling or on vacation so they can avoid dealing with doing testosterone injections.

Human Chorionic Gonadotropin (HCG)

HCG is an FDA approved medication that can help men with secondary hypogonadism send more signal to the testicles and potentially increase their natural testosterone production.

Also, many of our patients use HCG while doing testosterone injections to help reduce the risk of testicular shrinkage and maintain testicular function. Men on testosterone therapy who don’t use HCG may notice more testicular shrinkage.

Testosterone Therapy, In Conclusion

At Revive Low T Clinic we focus on low testosterone therapy and treatments as well as the diagnosis of low testosterone in men. It is important that we help you look for the cause of your low testosterone as well as help you find effective testosterone therapy and low testosterone treatment options.

While testosterone injections, topical testosterone, and HCG may have little to no side effects they certainly can cause side effects in some men. Prior to starting any low testosterone treatment or testosterone therapy we will discuss all your options as well as potential side effects.

Our goal is always to help you get the best results with the least amount of risk. We look forward to seeing you as a patient at one of our clinics.