Testosterone therapy has gained popularity among social media influencers and fitness enthusiasts in recent years. Many men struggling with low energy levels, sexual dysfunction, or perceived low musculature may wonder if they need testosterone therapy. While testosterone therapy is an effective treatment for low testosterone, patients should be well educated on the causes of low-T, treatment options, and side effects.
Related: Men’s Health: Testosterone Therapy
Testosterone in the body
Testosterone is a sex hormone that is necessary for both males and females. It is the primary sex hormone in men. Testosterone is responsible for development of the penis and testes, the deepening of the voice, and appearance of facial and pubic hair at the onset of puberty, bone growth and strength, libido, and sperm production. Testosterone also plays a role in muscle size and strength later in life.
In women, testosterone helps regulate ovarian function, improves bone strength, and may regulate libido.
Normal levels of testosterone in men can range between 300 ng/dL and 1050 ng/dL This is a wide range, and what feels normal for one man may be too low for another. Clinicians should consider serum testosterone levels in conjunction with patient symptoms. A patient with serum testosterone that falls within the normal range but who is experiencing symptoms of low testosterone may still benefit from testosterone therapy.
Symptoms of low testosterone
Men with low testosterone often report that they feel depressed, have little energy to do the things they enjoy, and have a low sex drive. While these symptoms may be caused by mental health disorders and other physical health problems, it is worth checking the testosterone levels of men complaining about these symptoms.
Other symptoms of low testosterone include:
- Reduced body and/or facial hair
- Reduction of muscle mass
- Generalized weakness and low energy levels
- Osteoporosis
- Sexual dysfunction
- Reduced sperm count
- Infertility
- Irritability
- Depression
- Small testicles
- Problems with memory and cognition
- Increased breast size
Causes of low testosterone
Hypogonadism is the most common cause of low testosterone. It is typically associated with Klinefelter syndrome, anorchia, or acquired disturbances of testicular function. These problems are typically easy to identify, and most patients start testosterone therapy at a relatively young age.
Other causes of low testosterone include autoimmune disorders, direct injury to the testes, including infection, radiation, chemotherapy, and tumors, or injury to the pituitary gland or hypothalamus. Some medications, such as anabolic steroids, can also cause low testosterone.
As men age, their levels of testosterone tend to drop. About 15% of men over the age of 50 are found to have low levels of testosterone. However, not all these men need testosterone replacement therapy. Only men who show clinical symptoms of low testosterone in conjunction with low serum levels benefit from testosterone therapy.
Related: Men’s Health: An Overview
Testosterone replacement therapy
Patients presenting with symptoms of low testosterone can have their serum levels checked by a physician. Patients with total testosterone levels lower than 300ng/dl almost always benefit from testosterone replacement therapy.
Timing is important when using testosterone therapy. Patients should take the medication at the same time each day. Discuss any decrease in dosing or skipped doses with a physician.
- Injections. Subcutaneous testosterone injections are the most effective treatment option for men and women with low testosterone. Because testosterone is a fat-soluble sex hormone, subcutaneous injections result in a steady and predictable release of testosterone. Most patients receive an injection every day or every other day.
- Patches. Patches may work for patients who have trouble with needles. These patches release a small amount of testosterone throughout the day. While they are effective, many men find that they cause itching and skin irritation.
- Gel. A topical gel works similarly to testosterone patches. Most patients rub the gel on to the back of their calves or Patients should wear gloves when they apply the gel and wash their hands thoroughly after each application. Label these gels clearly and keep them out of reach of children.
- Oral medication. Oral testosterone replacements are generally ineffective due to the first-pass effect in the liver. Studies report that patients taking oral testosterone supplements see little to no benefit.
Side effects of testosterone therapy
While testosterone therapy can be a great option for those with low serum testosterone levels and clinical symptoms, those who have normal testosterone levels and artificially raise their testosterone through supplementation may experience the following side effects:
- Low sperm count
- Shrinking of the testicles
- Increased risk of prostate cancer
- Impotence
- Insomnia
- Headaches
- Stunted growth, especially in adolescents
- Acne
- Higher risk of blood clots
- Risk of heart attack
- Liver disease
- Fluid retention
- Weight gain
- High blood pressure
- High cholesterol
- Prostate enlargement
- Mood swings
- Irritability
- Impaired judgment
Healthcare providers should educate men about the potential risks of using testosterone therapy when tests indicate it is not medically necessary. Men who want to use testosterone to increase their muscle strength and size should understand the risks associated with high testosterone levels.
