Hormone Deficiency, What is It?

Potential patients who are considering testosterone replacement therapy are naturally concerned about risks with treatment. Patients need to keep in mind that their bodies already produce testosterone. The testosterone molecule that is administered is the same as the one that the body produces naturally. The primary of goal of testosterone replacement therapy is to bring back the patient’s concentration of testosterone to a level that they had 10 to 20 years prior.

In some cases, patients may be advised to proceed with caution if certain health conditions exist, which is why a complete blood panel is done prior to administering any testosterone. As an example, testosterone may increase hematocrit, which is the ratio of red blood cells in the bloodstream. In the event that the hematocrit rises, there may be potential for the blood’s viscosity to change, making it thicker and prompting the possibility of stroke and or blood clots. However, this is only theoretical and there are almost no cases where medically supervised testosterone replacement therapy caused a stroke or serious clotting in a patient in the United States.

Moreover, in rare cases, medical professionals are hesitant in prescribing testosterone to patients with compromised liver function, weak kidneys, and/or any type of congestive heart failure. Testosterone may also cause an increase in oil that is produced by the skin which may result in acne, but this is in rare cases as is gynecomastia (an enlargement of the breast) and/or sleep apnea.

There have been several studies that examined whether there was an improvement in cognition as a result from TRT.

In one of the studies, the results showed that there was a significant improvement in cognitive function in men with testosterone deficiency syndrome where Low-T was related to cognitive impairment and depression.

The first type of testosterone preparation that is used in TRT is a topical gel, which can be administered by the patient themselves. Androgel and Testim, are the two most commonly prescribed topical testosterone gels in the United States. The gel is dispensed from a tube and is rubbed into the upper arms and/or shoulders once per day. While this method is convenient, the absorption of the gel for some patients is so poor that it will not yield enough testosterone to have the desired effect. Another topical type used in TRT is a patch, however, this method has a very high incidence of skin irritation in almost half of its users.

The second type of testosterone preparation used in TRT and the most reliable in getting results is an injectable. Absorption is not an issue as with the gel, and shots can either be administered at our office or by the patient depending on their knowledge and comfort level. The frequency of injections runs between once per week or once every two weeks.

Exogenous testosterone refers to testosterone that is manufactured outside the body, which is often used in TRT to treat hypogonadism. Typically exogenous testosterone is administered via injection. Endogenous testosterone differs because it is produced by the body. Recent research of clomiphene citrate, also known by its trade name as Clomid, which is generally prescribed to women with infertility problems in order to stimulate ovulation has shown some interesting results by increasing testosterone levels in men endogenously.

The recent off-label study, clomiphene citrate was administered daily to a group of men with low testosterone for a period of three months. Half way through the study it was discovered that all of the subjects had increased their testosterone levels with no side effects reported even a year after the study had been concluded.

Generally, men over the age of 40, have a 7-12% decline in their testosterone levels after mid-afternoon, which is why blood tests to check testosterone levels are administered in the mornings. Additionally, men who consume a high protein diet have higher testosterone levels.

Determining whether you are a candidate for Testosterone Replacement Therapy is determined by performing a blood test and the symptoms that the patient has experienced. Usually, men with lower testosterone have more of the symptoms that we discussed above while men with higher testosterone have less. However, in some cases, while a blood test may reveal low testosterone, there are no symptoms present.

If we are going strictly by the numbers, a total testosterone level that is below 300 ng/dl is medically considered low testosterone. This standard has been established by The Endocrine Society, which publishes recommendations and guidelines for clinical practice.

Speaking of total testosterone, not all testosterone in the body is available to the cells, approximately half of the testosterone in the body is bound to a sex hormone-binding globulin which is commonly referred to as SHBG. Free testosterone is the biologically available part of total testosterone and is the one that is accessible to the cells. Most blood tests will measure free testosterone, which is a strong indicator of Low-T.