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Testosterone Replacement Therapy
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There are a variety of terms used to describe the condition of low testosterone in the male
such as hypogonadism, andropause and androgen deficiency in the aging male
(A.D.A.M.). These terms are oftentimes used interchangeably and create confusion even
amongst healthcare professionals. All of these terms refer to a condition of low
testosterone that is associated with other symptoms. Some of these symptoms include a
decreased sexual drive, fatigue, erectile dysfunction, bone density loss and cognitive
changes which are all associated with low testosterone levels. Oftentimes these
symptoms are overlooked or attributed to some other condition such as normal ageing.
Effective therapy for low testosterone levels exists.
Why is my testosterone level low?
It is a well known fact that a man's testosterone level begins to decline as early as the age
of thirty (30). In fact, large longitudinal population studies have shown that a man's
tetsosterone decreases by approximately 1% per year after the age of 30. By the time a
man reaches the age of 60, there is a 20% chance that he will have a low testosterone
level. Most often the decrease in testosterone is associated with aging. Similar to when a
woman goes through menopause, men go through andropause but at a much slower rate.
Consequently, many of the symptoms associated with this condition can be insidious.
What are some other conditions associated with Hypogonadism?
Certain common conditions are frequently associated with low testosterone. The following
table lists some of these conditions.
such as hypogonadism, andropause and androgen deficiency in the aging male
(A.D.A.M.). These terms are oftentimes used interchangeably and create confusion even
amongst healthcare professionals. All of these terms refer to a condition of low
testosterone that is associated with other symptoms. Some of these symptoms include a
decreased sexual drive, fatigue, erectile dysfunction, bone density loss and cognitive
changes which are all associated with low testosterone levels. Oftentimes these
symptoms are overlooked or attributed to some other condition such as normal ageing.
Effective therapy for low testosterone levels exists.
Why is my testosterone level low?
It is a well known fact that a man's testosterone level begins to decline as early as the age
of thirty (30). In fact, large longitudinal population studies have shown that a man's
tetsosterone decreases by approximately 1% per year after the age of 30. By the time a
man reaches the age of 60, there is a 20% chance that he will have a low testosterone
level. Most often the decrease in testosterone is associated with aging. Similar to when a
woman goes through menopause, men go through andropause but at a much slower rate.
Consequently, many of the symptoms associated with this condition can be insidious.
What are some other conditions associated with Hypogonadism?
Certain common conditions are frequently associated with low testosterone. The following
table lists some of these conditions.
| Aging |
Metabolic Syndrome |
COPD/Sleep Apnea |
| Obesity |
Kidney Disease |
Stress |
| Diabetes Mellitus |
HIV/AIDS |
Chronic Infections |
| Chronic Opiod Use |
Sickle cell disease |
Medications |
How is hypogonadism diagnosed?
Alerting your physician to any of the symptoms asssociated with low testosterone is
important. A health inventory questionnaire called the A.D.A.M questionnaire was
designed to identify patients who potentially might have low testosterone levels. If you
answer yes to any three questions or to any single sexual question, there is a strong
possibilty that you have a low testosterone level. Your physician will order confirmatory lab
tests prior to commencing any therapy.
What types of treatment options are available for men with low
testosterone levels?
There are a variety of treatment options available for the man with low testosterone levels.
Currently, there are oral, buccal, transdermal gels, patches, intramuscular injections and
subcutaneous pellets available to treat hypogonadism. Each form of therapy has specific
advantages and disadvantages associated with it. You can discuss with your physician
which form of therapy is right for you.
What are the risks of testosterone replacement therapy?
In general, testosterone replacement therapy is very safe. People oftentimes confuse the
difference between replacing testosterone in the body to return it to normal physiologic
levels with taking testosterone to achieve "super-physiologic" levels for performance
enhancement. These are clearly two different situations. The biggest concerns are
related to prostate health and the development of prostate cancer. Many hypogonadal men
might notice a slight worsening of their urinary symptoms or increase in their PSA. This
occurs because the prostate and PSA are directly controlled by testosterone. Replacing
testosterone into the normal range only increases urinary symptoms and PSA into the
range where they would be if the testosterone level was not low in the first place. Men with
testosterone levels in the normal range (300-1000 ng/dl) are at no greater risk of
developing prostate cancer than their hypogonadal counterparts. Hypogonadism is not
only not protective against prostate cancer, there is some evidence to suggest that
hypogonadal men might develop a more aggressive form of prostate cancer. Men on
testosterone replacement therapy appear to have improved angina-free exercise periods
and better cholesterol profiles than their hypogonadal counterparts. The risks of
osteoporosis and fractures are reduced in men on testosterone replacement therapy.
What are some of the other resources available to better understand my
condition?
For a more detailed discussion about hypogonadism and testosterone replacement
therapy, read Dr Karpman's article:
The Therapeutic Challenges of Hypogonadism and Its Comorbidities
Alerting your physician to any of the symptoms asssociated with low testosterone is
important. A health inventory questionnaire called the A.D.A.M questionnaire was
designed to identify patients who potentially might have low testosterone levels. If you
answer yes to any three questions or to any single sexual question, there is a strong
possibilty that you have a low testosterone level. Your physician will order confirmatory lab
tests prior to commencing any therapy.
What types of treatment options are available for men with low
testosterone levels?
There are a variety of treatment options available for the man with low testosterone levels.
Currently, there are oral, buccal, transdermal gels, patches, intramuscular injections and
subcutaneous pellets available to treat hypogonadism. Each form of therapy has specific
advantages and disadvantages associated with it. You can discuss with your physician
which form of therapy is right for you.
What are the risks of testosterone replacement therapy?
In general, testosterone replacement therapy is very safe. People oftentimes confuse the
difference between replacing testosterone in the body to return it to normal physiologic
levels with taking testosterone to achieve "super-physiologic" levels for performance
enhancement. These are clearly two different situations. The biggest concerns are
related to prostate health and the development of prostate cancer. Many hypogonadal men
might notice a slight worsening of their urinary symptoms or increase in their PSA. This
occurs because the prostate and PSA are directly controlled by testosterone. Replacing
testosterone into the normal range only increases urinary symptoms and PSA into the
range where they would be if the testosterone level was not low in the first place. Men with
testosterone levels in the normal range (300-1000 ng/dl) are at no greater risk of
developing prostate cancer than their hypogonadal counterparts. Hypogonadism is not
only not protective against prostate cancer, there is some evidence to suggest that
hypogonadal men might develop a more aggressive form of prostate cancer. Men on
testosterone replacement therapy appear to have improved angina-free exercise periods
and better cholesterol profiles than their hypogonadal counterparts. The risks of
osteoporosis and fractures are reduced in men on testosterone replacement therapy.
What are some of the other resources available to better understand my
condition?
For a more detailed discussion about hypogonadism and testosterone replacement
therapy, read Dr Karpman's article:
The Therapeutic Challenges of Hypogonadism and Its Comorbidities
Testosterone Replacement Therapy
| In The News |
The ratio of
testosterone-to-PSA predicts
prostate cancer in
hypogonadal men
Journal of Urology, May 2008
Testosterone link to
depression
BBC News, March 4, 2008
Testosterone insufficiency
increases death risk in older
men
(Urology Times, Nov 1, 2007)
Efficacy of changing
testosterone gel
preparations in suboptimally
responsive hypogonadal
men. (Int J Impot Res, Sept
2007)
Low Testosterone May
Increase Mortality. (Renal &
Urololgy News
Sept 2007)
Decline in testosterone
levels seen among American
men (Urology Times,
December 7, 2006)
TRT appears prostate-safe in
6-month trial (Urology Times,
August 1,2006)