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Testosterone Replacement Therapy (TRT) is a medical treatment aimed at increasing testosterone levels in individuals with low testosterone (low T) – as defined by both abnormal symptoms and lab testing. TRT involves the administration of synthetic testosterone to supplement the body’s natural production of this hormone.
This therapy comes in various forms, including injections, topical gels, patches, pellets, and oral medications. The goal of TRT is to restore testosterone levels to a normal range (400-700 ng/dL), and alleviate symptoms associated with low T such as fatigue, low libido (desire to have sex), erectile dysfunction, decreased muscle mass, and mood changes.
For safe and effective therapy, TRT is prescribed and monitored by healthcare providers who assess the patient’s symptoms, medical history, and hormone levels before initiating treatment. Regular follow-up visits and periodic blood tests are needed to monitor the effectiveness and safety of TRT and to adjust the treatment dose as needed.
It’s essential for individuals considering TRT to discuss the potential benefits, risks, and side effects with their healthcare provider to make informed decisions about their treatment options.
While it’s natural for hormone levels to decline with age (and men still have normal function), low testosterone can result from various factors beyond aging. Factors such as testicular injuries, infections, undescended testicles, or genetic conditions can all occasionally contribute to low testosterone levels.
When low testosterone is caused by testicular issues such as age decline or trauma, it’s termed primary hypogonadism. Conversely, if the underlying cause is related to the brain-stimulating centers of testicle function (pituitary gland), it’s referred to as secondary hypogonadism.
Low libido, decreased morning erections and erectile dysfunction can all be indicators of low testosterone, but other less specific symptoms like low energy levels, cognitive brain fog, and changes in body composition may also be present. If you’re experiencing any of these symptoms, it’s essential to seek medical assistance promptly.
To assess testosterone levels and diagnose low T, Treasure Valley Family Medicine will perform a clinical history and use blood tests to measure the amount of testosterone in your bloodstream. Additionally, we will perform physical examinations to check for any signs of underlying conditions affecting the testicles or hormonal regulation centers in the brain as indicated.
These evaluations help us determine what low T levels are due to hypogonadism or other factors. Based on the results, we can then develop a personalized treatment plan tailored to your specific needs and health goals.
Options for treating low testosterone may include direct hormone replacement therapy (TRT), which involves administering testosterone in various forms such as injections or topical gel. The choice of treatment depends on factors such as the severity of the condition, individual preferences, and any underlying health considerations. Injection therapy weekly is typically the cheapest and most reliable option, but men may not accept recurring needle injections. Topical gels are applied daily and work for most but not all men due to absorption issues. They are more expensive but more acceptable to most men. Nonstandard options include pellets deposited surgically for 3-6 months but they are not FDA-approved nor covered by insurance. The dose cannot be adjusted until the pellets wear off. TVFM does not offer this noncovered option. Additionally, lifestyle modifications such as regular exercise, a balanced diet, stress management techniques, and adequate sleep to include treatment of sleep apnea can also play a crucial role in managing low testosterone levels.
Testosterone plays a crucial role in various aspects of your health, including the development and maintenance of sex organs, muscle mass, bone density, sex drive, and red blood cell levels. It also contributes to your overall sense of well-being.
Testosterone Replacement Therapy (TRT) does come with some potential risks and side effects, especially when men are treated above the safe goal range with too high of dose. These risks can include:
Testosterone Replacement Therapy (TRT) can be administered through various methods, including:
The choice of administration method depends on factors such as patient preference, convenience, effectiveness, and healthcare provider recommendations. Each method has its advantages and disadvantages, and individuals should discuss their options with their healthcare provider to determine the most suitable approach for their needs.
Just as the ovaries in women wind down over time causing menopause and hot flashes, male gonads (testicles) also wind down over time though not as severely. Additionally, luteinizing hormone (LH) produced in the brain’s pituitary gland which stimulates testosterone production will also tire out over time causing age related hormone decline.
Without insurance, injectable therapy will often be cheaper (less than $50 month) compared to topical gels ($50-$100 month) or pellets ($$$ hundreds plus the surgery bill). The website GoodRx.com is useful to compare pharmacy cash pricing. With insurance, copays will wildly vary and be policy specific.
Injectable testosterone cypionate and topical testosterone gel such as Androgel® are almost always covered, often with a prior authorization required to ensure it is being used for testicular failure in a biologic male and not being used solely for age-related decline or transgender care (insurance criteria that will usually result in a “not covered” rejection letter). Pellets will not be covered when compounded and have variable coverage when using the FDA approved version Testopel®.
TRT can be used in the 30s if appropriate symptoms and abnormal labs are found. Of note, younger men should be clear that testosterone may adversely impact sperm production and pregnancy.
