What is Testosterone?
Testosterone is a crucial hormone found in all mammals, produced in specialized structures known as gonads. In men, it is synthesized in Leydig cells within the testes, while in women, it is produced in the ovaries. Hormones like testosterone play a vital role in numerous biological functions, including growth, immune function, metabolism, and sexual reproduction. They stimulate, regulate, and control these essential processes in the body.
What Are the Symptoms of Low Testosterone?
Low testosterone can manifest in various ways, including:
- Weight gain
- Weakness
- Decreased endurance
- Anxiety
- Mental confusion
- Fatigue
- Depression
- Low self-esteem
- Decreased muscle mass
- Lack of motivation
- Erectile dysfunction
- Reduced interest in sex
- Decreased penile rigidity
How Does Testosterone Affect Libido and Erectile Ability?
Testosterone directly influences libido and erectile function by facilitating blood flow in the corpora cavernosa, the erectile chambers of the penis. As men age, they may still achieve erections but often struggle to maintain the rigidity they had in their youth. The most effective method for restoring better-quality erections, without relying on erectile dysfunction medications, is testosterone replacement therapy. Many men are unaware of the significant decline in their sex drive or low hormone levels until they experience improvement following therapy.
How Is Low Testosterone Checked?
A simple blood test is used to measure low testosterone levels, specifically assessing free testosterone rather than total levels. Only about 2% of the total testosterone in your bloodstream is biologically active (free testosterone). The remaining 98% is bound to sex hormone-binding proteins, rendering it unavailable for use. Testing solely for total testosterone levels is ineffective because free testosterone is what enters the body and facilitates symptomatic improvement.
How Is Low Testosterone Treated?
We approach the treatment of low testosterone with a comprehensive combination of lifestyle changes and high-quality, time-released intramuscular injections administered weekly or biweekly. Transdermal (through the skin) therapy has not yielded satisfactory results in men; it is poorly absorbed, easily transferable to women and children, and can be quite expensive—up to $600 per month. Due to difficulty controlling dosage, it is effective in only about 15% of men. Additionally, transdermal testosterone is absorbed by the lymphatic system, where it may be converted to dihydrotestosterone (DHT), potentially causing hair loss and growth of prostate cells. Over time, transdermal therapy may also lead to reduced effectiveness.
What Are the Health Benefits of Testosterone Replacement Therapy?
Testosterone replacement therapy can provide numerous health benefits, including:
- Reducing symptoms of depression and promoting a better mood
- Increasing libido or sex drive
- Regulating body fat distribution and aiding weight control
- Enhancing lean muscle mass
- Boosting energy and vitality
- Improving bone density
- Increasing strength and endurance
- Lowering the risk of heart disease
- Enhancing blood sugar control
- Improving spatial memory and cognitive function
- Alleviating symptoms of metabolic syndrome
- Enhancing overall quality of life
Why Have the Number of Low Testosterone Patients Increased Dramatically in the Last 20 Years?
Testosterone levels have been declining over the past few decades due to various environmental and lifestyle factors. Our society experiences higher stress levels combined with decreased physical activity. Obesity rates have soared due to excessive consumption of processed foods, high in soy, and increased exposure to herbicides, pesticides, and bisphenol plastics. Substance abuse, particularly involving alcohol, caffeine, marijuana, and opioids, has also risen. At our clinic, we encourage patients to disclose their lifestyle choices fully so we can develop tailored strategies that support their health and improve their quality of life.
Why Is Estrogen Important in Managing Male Hormones?
Estrogen and testosterone share a close structural relationship. The conversion of testosterone to estrogen is facilitated by the enzyme aromatase. Some patients have inherently high aromatase activity regardless of lifestyle changes. Testosterone levels peak in early adulthood but decline with age, leading to rising estrogen levels that can dominate. Effective management of testosterone replacement therapy involves maintaining a balanced ratio of testosterone to estrogen. When testosterone levels rise, estrogen levels often follow suit, which can blunt the efficacy of injections. To manage this, I prescribe estrogen blockers, also known as aromatase inhibitors. Many prescribers do not realize the importance of managing estrogen alongside testosterone therapy. I prefer to avoid unnecessary medications for my patients, prescribing estrogen blockers only when they experience symptoms of excess estrogen, such as fluid retention, nipple sensitivity, breast tenderness, emotional changes, or difficulty losing weight. In such cases, I order blood work to assess and adjust treatment effectively.
How Can I Become Your Patient?
Becoming a patient at Fountain Of You MD is straightforward. Simply give us a call or use our online scheduler to book your consultation. The initial visit includes a review of your vital signs, a comprehensive and personalized consultation, and any necessary blood work. We aim to make this process as educational and simplified as possible. Our website provides a wealth of information that can benefit all individuals. Potential patients are encouraged to explore the resources available to understand our treatment methods. Once your test results are reviewed, I will personally notify you with a recommended treatment regimen. If the screening criteria are met, therapy may begin immediately.
How Often Will I Receive Injections?
We adhere to the standard of care recommended by the Food and Drug Administration and most pharmaceutical manufacturers, which typically indicates a 14-day treatment protocol. The dosage amount is the only variable, as testosterone injections generally last approximately 15 to 17 days before levels significantly drop.
Can I Self-Inject at Home?
We understand that your time is valuable, and we are happy to provide education on proper sterile technique, storage, drawing technique, and injection methodology. However, we do require you to attend all necessary follow-up visits to ensure compliance with dosing and monitoring blood work.
Why Can’t I Just Video Chat or Get a Telemedicine Consultation for Testosterone Replacement Therapy?
Testosterone is a controlled substance that requires periodic in-person evaluations. It is illegal to prescribe or administer testosterone replacement therapy via telemedicine.
How Long Until I See Results?
Many patients report significant improvements as soon as two months into continuous therapy, although results may vary from person to person.
Is Testosterone Replacement Therapy Safe?
Testosterone replacement therapy has been studied and utilized for decades, with no adverse health risks reported in clinical studies.
What Are Some Possible Side Effects of Testosterone Replacement Therapy?
Potential side effects of testosterone replacement therapy may include:
- Secondary polycythemia, which is an increase in red blood cell count. If hemoglobin or hematocrit levels become too high, this may pose a health risk.
- Decreased spermatogenesis and sperm count, though this is typically reversible after discontinuing therapy.
- Testicular shrinkage or atrophy, as testosterone replacement therapy can cause the body to reduce its own testosterone production. This can be managed with human chorionic gonadotropin (HCG), a naturally occurring hormone that signals the testicles to produce more testosterone. HCG also boosts follicle-stimulating hormone and progesterone, increases ejaculatory volume, and preserves spermatogenesis.
- Mild fluid retention, increased body hair, injection site reactions, mild acne, oily skin, and flushing have been reported in a small minority of patients (less than 6%).
- Increased aggressive behavior
- Breast enlargement
- Increased urination
What Happens If I Stop Therapy?
If you discontinue testosterone replacement therapy, your testosterone levels will return to their pre-therapy levels. To prevent abrupt changes, I can ease patients off therapy with a 6-week regimen of novel testosterone replacement therapy to avoid crashing. If you have further questions or would like to schedule a consultation, please do not hesitate to contact us. We are here to assist you on your journey to better health.
