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Low Testosterone

Base Healthcare Adequate Testosterone Therapy™ (ATT) is an oral treatment to maintain daily balanced levels of testosterone. Visit our Cary, NC location or setup an online appointment to learn more about how ATT can revitalize your life.  

Table of Contents:

What is Low Testosterone?

Testosterone, which is produced in the testicles, is the primary male sex hormone. It plays a crucial role in normal male sexual development and function. During adolescence, testosterone contributes to the development of male traits such as facial and body hair growth, a deeper voice, and improved muscle strength. It is also necessary for the production of sperm in men. Unfortunately, testosterone levels tend to decrease as men age, resulting in lower testosterone levels in older men. 

When men have low testosterone levels, it is referred to as Testosterone Deficiency Syndrome (TD) or Low Testosterone (Low-T). Deficiency means insufficient levels of a necessary substance, while syndrome refers to a group of symptoms that suggest a particular condition. Hypogonadism occurs in males when the testicles are not producing enough testosterone. 

Do you have Low Testosterone?

According to the American Urology Association (AUA), low blood testosterone (Low-T) is defined as a testosterone level below 300 ng/dL. Low-T may be accompanied by the following symptoms or conditions: 

  • Decreased sex drive 
  • Fatigue 
  • Decreased muscle mass 
  • Irritability 
  • Erectile dysfunction 
  • Depression 

It is important to note that there may be other causes for these symptoms, such as opioid use, certain congenital conditions, testicular damage or loss, diabetes, and obesity. If you are experiencing any of these symptoms, it is recommended that you see a doctor. 

Who is most affected by Low Testosterone?

Male hypogonadism is a medical condition that can occur at any stage of life, from birth to adulthood, in individuals with testicles. Low testosterone levels are more likely to affect individuals who: 

  • Are older in age 
  • Have obesity 
  • Have pre-diabetes or poorly managed Type 2 diabetes 
  • Have obstructive sleep apnea 
  • Have chronic medical conditions such as kidney dysfunction or liver cirrhosis 
  • Have HIV/AIDS 

Determining the exact prevalence of low testosterone levels is challenging due to the varied definitions used by different studies. Some studies suggesting that the likelihood increases with age, with nearly 39% of men ages 45 years and older having low testosterone levels. 

How is Low Testosterone diagnosed?

While there are various symptoms that may be associated with Low Testosterone (Low T), the most crucial indicator of testosterone deficiency is the total blood testosterone level. Your doctor will use this information in conjunction with other specific signs and symptoms to make a diagnosis 

Health History 

During your medical evaluation, your doctor may ask you about the following:  

  • Headaches or changes in your visual field (which may be a symptom of a brain mass, such as a pituitary tumor) 
  • Your development during puberty 
  • Previous infections in the testicles 
  • Testicular injury 
  • Mumps after puberty 
  • A history of pre-diabetes or diabetes 
  • Previous chemotherapy or radiation therapy 
  • Family history of diseases linked to low testosterone 
  • History of stroke or heart attack 
  • Unexplained cases of anemia 

Physical Examination 

During your physical exaination, your doctor will: 

  • Measure your Body Mass Index (BMI) or waist circumference to assess for obesity  
  • Evaluate for Metabolic syndrome, which is a group of symptoms that includes elevated blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels  
  • Observe hair pattern, amount, and location 
  • Check for gynecomastia (enlarged breasts)  
  • Assess the presence and size of testicles 
  • Evaluate the size and any abnormalities of the prostate 

Testing for Low Testosterone 

Your doctor may order the following blood tests: 

  • Total testosterone measurement: A sample should be taken before noon as testosterone levels tend to decrease later in the day. Your doctor may wait until you are not sick as illness can affect test results. 
  • Luteinizing hormone (LH) test: This test helps determine the cause of low testosterone levels. An abnormal LH level could indicate a problem with the pituitary gland. 
  • Prolactin level check: If the prolactin level is elevated, your doctor may repeat the test to confirm. Elevated prolactin levels can be a sign of pituitary problems or tumors. 
  • Hemoglobin (Hgb) measurement: Your doctor will consider other potential causes of low Hgb such as altitude, sleep apnea, or smoking before conducting this test. 
  • Follicle stimulating hormone (FSH) test: This test assesses sperm production, and may be required if you wish to have children. Semen testing may also be necessary. These tests will be performed prior to any hormone therapy. 
  • Estradiol hormone test if there are breast symptoms. 
  • HbA1C blood test for diabetes evaluation. 

How is Low Testosterone treated?

According to the AUA, testosterone replacement therapy should only be prescribed to men who fit the criteria for testosterone deficiency, which is defined by a testosterone level below 300 ng/dL. 

If you present any of the following conditions, your doctor will probably check your testosterone levels: 

  • Unexplained anemia  
  • Diabetes  
  • Bone density loss  
  • Low-trauma bone fracture 
  • Radiation to the testicles  
  • Positive HIV/AIDS test results 
  • Chronic narcotic use 
  • Infertility 
  • Pituitary gland disorders 

Even if you don’t show any symptoms, your doctor may still test your testosterone levels if you have a history of: 

  • Insulin resistance 
  • Chemotherapy 
  • Corticosteroid use 
  • Lifestyle changes such as losing weight and getting more physical activity will likely raise your testosterone levels.  
  • Your doctor will monitor your hemoglobin/hematocrit levels while on testosterone therapy to check for blood thickening, which can lead to blood clots. 
  • If you are at risk of heart disease, your doctor will closely monitor you while on testosterone therapy and encourage healthy changes to reduce the risk of heart and blood vessel disease. 
  • The target level of testosterone may vary, but the goal is to raise it above 300 ng/dL. You should notice improvement in symptoms within three to six months of treatment, but if your testosterone levels return to normal and you still have symptoms, your doctor may discontinue therapy and look for other underlying causes. 

What are the treatment options for Low Testosterone?

Healthcare providers offer testosterone replacement therapy as a treatment for low testosterone, also known as male hypogonadism. This therapy is available in several forms, including: 

  • Orals: A pill form of testosterone called undecanoate is available for people who prefer to use needles several times a month or don’t see improvement from applying gels or patches. The oral capsule is easy to consume and maintains adequate levels of Testosterone throughout the month.  
  • Gels: As directed, apply the gel to clean, dry skin on a daily basis. It is crucial to avoid transferring the gel to others through skin-to-skin contact. Testosterone skin gels are one of the most widely used forms of treatment in the United States. 
  • Intramuscular injections: Injections can be self-administered or given by a provider into a muscle, with intervals of every 1 to 2 weeks. Long-acting testosterone injections can be administered by a provider every 10 weeks. Subcutaneous injection options are also available. 
  • Patches: You apply these patches daily to the skin as directed, typically rotating their placement to prevent skin irritation. 
  • Pellets: Healthcare providers implant these pellets under the skin every three to six months to provide consistent, long-term testosterone doses. 
  • Nasal gel: You apply the testosterone gel by administering it into each nostril three times daily.