Male hypogonadism Diagnosis & treatment

Visual Guide to Low Testosterone

The rate of new diagnosed cases of type II diabetes in 10–19 year olds rose most sharply in Native Americans (8.9%) an, Asian Americans/Pacific Islanders (8.5%) and non-Hispanic blacks (6.3%) (23). Your ovaries, adrenal glands and other tissues and cells produce testosterone. Too little or too much testosterone can affect your overall health and impact the levels of other sex hormones in your body. The side effects of testosterone on females aren’t fully understood. Many treatment methods for low testosterone are unregulated and not widely studied. Only you and your healthcare provider can decide what’s best for you based on your symptoms and bloodwork.

Studies to answer these questions are under way, but it will be years before we know the results. In the meantime, remember that testosterone replacement hasn’t been conclusively shown to improve any health condition other than testosterone deficiency and its symptoms. For men with low testosterone levels as measured by a blood test who also have symptoms of low testosterone, the decision to take testosterone replacement is one to make with your doctor. With injectable testosterone, measurement of testosterone levels is best done at ‘trough’, immediately before an injection is due.

Those low levels cause decreased testosterone and sperm production. All men with low testosterone levels are at an increased risk for developing osteoporosis, or weakening of the bones, and should receive counseling on osteoporosis prevention. Though it is not included in the ASA guidelines, I recommend to consider obtaining a DEXA scan (which evaluates bone density) in men with a baseline total testosterone of less than 200 ng/dL. See the «Osteoporosis» section of this website for more information. For example, let’s say a man who has been taking exogenous androgens for low T comes to my office for fertility treatment.

The effects of TRT can be felt within just a few weeks, but full benefits may take several months to manifest. The timeline can vary depending does being on testosterone make you infertile the individual’s baseline testosterone levels, the form of therapy chosen, and their overall health. Regular follow-up with a healthcare provider is crucial to monitor the therapy’s effectiveness and make any necessary adjustments. Developing diabetes increases the risk of having a total testosterone level of less than what is considered normal.

If a pituitary problem is the cause, pituitary hormones can be given to help the body make more sperm and restore fertility. A pituitary tumor may need treatment with surgery, medicine, radiation or replacement of other hormones. For older adults who have low testosterone and symptoms of hypogonadism due to aging, it’s less clear how well testosterone replacement works. Even the sexual symptoms can be due to many other conditions, including vascular disease, chronic alcohol use, and depressive disorders. Thus, many men are seeking solutions for these bothersome symptoms, which may involve indiscriminant testing and possible overtreatment. Secondary hypogonadism is caused by damage to the pituitary gland or hypothalamus. These parts of the brain control hormone production by the testes.

Many men with low testosterone levels report that they feel better and have more energy while taking testosterone. If you have low T, there could be an underlying cause that isn’t directly linked to aging. For example, sleep apnea, obesity, diabetes, certain medications, high cholesterol, high blood pressure, injuries and excessive alcohol use can cause low testosterone. In many cases, identifying and treating your underlying cause or condition may result in improvements in your testosterone levels. Also, lifestyle changes such as abstaining from drinking alcohol, exercising regularly or changing certain medications may further improve your testosterone levels. Testosterone deficiency is more common in men who are overweight or obese.

However, a man’s PSA levels might increase during testosterone therapy, so it is important to monitor them. A urologist may also conduct a PSA (prostate-specific antigen) blood test to check for signs of prostate cancer. He/she may also measure the red blood cells in the body (hematocrit) to keep a baseline record of red blood cell counts, because they can go up after taking testosterone.

However, SERMs can raise FSH levels, so if the FSH is inappropriately low in a man receiving HCG, then adding a SERM to HCG might be of benefit. Also, some boys who are delayed entering puberty (after age 14) may also benefit from testosterone injections. First, other problems, including isolated gonadotropin deficiency (a lifelong deficiency of certain puberty hormones), should be ruled out. If a man’s testosterone is below 300 ng/dL, his doctor may prescribe testosterone replacement therapy. However, these symptoms are often caused by other things, including poor sleep habits, sleep apnea, diabetes, cardiovascular disease, obesity, and depression or anxiety, he says. Regular follow-up visits are necessary to evaluate a man’s response to testosterone therapy and to check routine testosterone related blood tests.