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Urology: Help for Testosterone Deficiency

HealthReach, Spring/Summer 2012 | page 5

Testosterone deficiency is a disorder that can have an important effect on men’s health. Urologist Gregory Bernstein, MD of Washington Urology and endocrinologist Caroline Huang, MD explain the underlying reasons for testosterone deficiency and when it is appropriate to treat it with testosterone replacement therapy (TRT).

What is testosterone?

Men produce testosterone throughout their entire lives. As a hormone, it is important for sperm production and fertility. It also helps maintain healthy heart, brain and muscle systems. There can be an age-related decline in testosterone of 1 to 2 percent per year, but not all men have a decrease in testosterone. If you are tired or have a change in erection and sexual function, don’t attribute this to just getting older. There may be an underlying cause for these symptoms.

What are the symptoms of testosterone deficiency?

The most common symptoms are weight gain around the mid-section, fatigue, decreased libido and muscle strength, some sleep disruption, cognitive changes in concentration and memory, and erectile dysfunction (ED). It also can cause anemia and severe osteoporosis. Any man with a history of adult fractures can be treated and should have his testosterone checked. However, these same symptoms also can be caused by other conditions. A thorough exam is needed to find out if the problem is due to testosterone deficiency. Proper diagnosis is key.

What causes it?

Most often decline in testosterone levels are due to the aging process and decline in testicular function; however, it can be caused by many conditions, including testicular injury or trauma, infection, hormonal disorders such as a pituitary tumor, diabetes, high blood pressure and HIV/AIDS. Some medications and genetic syndromes, such as Klinefelter’s, also can cause low testosterone.

How do you test for testosterone deficiency?

In addition to a physical exam, we check testosterone levels with a blood test. Testosterone levels vary throughout the day, with the highest levels typically occurring in the morning. Therefore, it is best to have the testosterone levels checked with a morning lab test.

What is TRT (testosterone replacement therapy)?

A topical gel or patch applied to the skin once a day provides the most even, steady-state levels of testosterone replacement. It also can be replaced via injections once or twice a month, however, this method of testosterone replacement leads to more daily variability in the testosterone levels. Another alternative for TRT is through dissolvable testosterone pellets that are implanted under the skin. These pellets deliver testosterone to the body and are effective for up to three to four months at a time.

Will TRT improve the symptoms?

Yes, if the symptoms are due to low testosterone. TRT can improve sexual interest, erectile function, mood and energy, body hair growth, bone density and muscle mass. For some men, TRT can be life-changing. They can feel so much better. However, if symptoms persist after the patient is put on TRT and achieves normal testosterone levels, then we need to explore other causes and do further evaluation.

Is it safe?

TRT is safe when it’s monitored and used at the prescribed dosage. Blood levels are monitored every few months until a steady level of testosterone is achieved and then every six months for follow-up. If it improves symptoms, TRT can be a lifelong therapy. The types of symptoms patients experience from low testosterone levels also may be due to other health conditions. It’s important to talk to your doctor about your symptoms to determine the appropriate care plan for you.

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