Testosterone Replacement Therapy

Testosterone Replacement Therapy for Meridian, Boise, Nampa and Eagle Idaho

What is TRT?

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.


How do I know if I have low T?

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.

Diagnosing Low Testosterone With Treasure Valley Family Medicine

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.

What Options exist to treat Low T?

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.

Why TRT Injections?

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.

Are there any risks linked to TRT?

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:

  1. Increased Risk of Blood Clots: TRT may increase the risk of forming blood clots, particularly in older men or those with pre-existing cardiovascular conditions.
  2. Acne and Skin Reactions: Some individuals may experience acne or skin reactions at the site of testosterone application, especially with topical treatments like gels or patches.
  3. Fluid Retention: TRT can cause fluid retention, leading to swelling in the legs or ankles, particularly in individuals with heart or kidney problems.
  4. Increased Risk of Prostate Issues: There is some concern that TRT may exacerbate prostate enlargement (benign prostatic hyperplasia) or increase the risk of prostate cancer, although research on this topic is ongoing and results are mixed.
  5. Decreased Fertility: TRT can suppress sperm production, leading to decreased fertility. Men interested in preserving fertility should discuss this with their healthcare provider before starting TRT; treatment with off-label clomiphene can help. 
  6. Mood Changes: While TRT can improve mood and overall sense of well-being in some individuals, it may also cause mood swings, irritability, or emotional instability in others, especially at doses that are too high..

How is TRT administered?

Testosterone Replacement Therapy (TRT) can be administered through various methods, including:

  1. Intramuscular Injections: Testosterone injections are typically given into the muscles of the outer mid-thigh (or buttocks in the upper outer gluteal muscles) every week. This method provides a peak and trough testosterone level that aims to stay within the goal range. 
  2. Transdermal Patches: Transdermal patches are applied to the skin, usually on the back, abdomen, upper arms, or thighs. The testosterone is absorbed through the skin and enters the bloodstream.
  3. Topical Gels: Testosterone gels are applied to the skin, usually on the upper arms, shoulders, or abdomen. The gel is absorbed through the skin, delivering testosterone into the bloodstream daily. It’s important to allow the gel to dry completely before covering the area with clothing.
  4. Subcutaneous Pellets: Small pellets containing testosterone are implanted under the skin, typically in the buttocks or abdomen, during a minor surgical procedure. The pellets slowly release testosterone over 3-4 months.

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.


Why does T decrease with age?

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.

What is the average cost of testosterone therapy?

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.

Is TRT usually covered by insurance?

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®.

Should I do TRT in my 30s?

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.


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