HOW IS LOW TESTOSTERONE (LOW-T) TREATED?
The great news for men with low-T is that treatment of low testosterone in hypogonadism is a fully accepted therapy. Discuss your testosterone levels, symptoms, and side effects of treatment with your doctor to establish whether you should receive therapy and what form of therapy. Testosterone may be administered, when clinically appropriate, through 1 of 3 methods, depending on the patient’s needs:
TOPICAL TESTOSTERONE
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The use of creams and gels are very common, requiring daily application once or twice a day. There are FDA approved topical testosterone and testosterone patches. We can also have testosterone cream and gels compounded to a specific dose for a particular patient. The upside to using a topical testosterone there is no injection. However, there are a few important concerns when it comes to topical testosterone.
Topical testosterone sounds quick and easy, but there are some important concerns which we have to take into account prior to prescribing. Topical testosterone can be transferred through the clothes for up to 12 hours after application. What does this means for patients? We do not recommend topical to men with small children because they can transfer it to the kids. Not only does testosterone transfer occur up to 12 hours after application, if you are not careful with your hygiene after application will also inadvertently transfer testosterone to others. For instance, lets say you apply your testosterone gel a with your right hand and then you use that hand to open the faucet, you will leave some residual testosterone on the tap and some who comes along and opens that faucet later will inadvertently absorb testosterone. Men who are married or involved in a relationship should really consider not using topical testosterone because it can be transferred during intimacy. |
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Testosterone Injections
Many men who seek testosterone replacement therapy prefer injectable therapy For those who are interested in doing self injections, Our office will schedule a training session with Dr. Bissoon in order to teach you how to perform self injections safely. This session takes about 10-15 minutes. Treatment by injection is often a better option; a shot of testosterone is usually performed 1-2 times a week based on the dose. Dr. Bissoon does prefer twice a week dosing with smaller doses to avoid extremely high and low levels. The down side is the hassle of self injection and the pain associated with the shot. In addition to the pain associated with the injection there may be some pain from the actual testosterone –which is rare.
Injectable testosterone is in an oil base and can produce some muscle soreness after injections. The oil base allows for the testosterone to be time released for 7-10 days. With testosterone injections, the injection sites can be rotated between injections. There is also the potential to develop a skin infection at the injections site-which is why we do an injection training session. This is extremely rare if you follow the injection technique as taught.
Many men prefer this option and it is the most popular option. This is a good option for men who are married or are involved in a relationship, men with small kids and single guys.
Injectable testosterone is in an oil base and can produce some muscle soreness after injections. The oil base allows for the testosterone to be time released for 7-10 days. With testosterone injections, the injection sites can be rotated between injections. There is also the potential to develop a skin infection at the injections site-which is why we do an injection training session. This is extremely rare if you follow the injection technique as taught.
Many men prefer this option and it is the most popular option. This is a good option for men who are married or are involved in a relationship, men with small kids and single guys.
Long Term Testosterone Pellets
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Recently, the FDA approved implantable testosterone pellets for men which can last about 5-6 months. This is a major breakthrough since the pellets need to be implanted 2-3 times a year beneath the skin in the upper part of the buttocks. Obviously, this option of testosterone replacement is new to the market but appears to be a better choice for longer lasting therapeutic results. It also eliminates the need for daily creams, gels, troches and weekly injections.
This is a good option for men who do no want to deal with the hassles of daily injection, but are not candidates for the topical application. Men who travel frequently for business may want to choose this option, as going through airport security with injectable testosterone, syringes and needles or topical testosterone may be a problem with international travelers. The downside to implantable pellets is that if requires a minor in office surgical procedure which takes about 15-20 minutes from start to completion. Most insurance companies prescription plans will pay for the pellets, you will still be responsible for the copayment and the cost of the procedure. Of the available options this is the most expensive. |
THINGS TO CONSIDER BEFORE ANY TREATMENT
Low testosterone levels can have an impact on your life but so can too much testosterone and it is important to have your physician explain all the potential side effects and implications of getting testosterone replacement therapy.
A potential issue is the male equivalent of female menopause (andropause). There is decreased production of testosterone or bioavailability of testosterone and a decrease in libido.
The reality is that irrespective of the approach taken, when you start a testosterone treatment program some of your testosterone will be converted to estrogen and some will be converted to DHT. For those who don't know, estrogen can have it's own not-so-fun side effects like increasing belly fat, impotence and female breast tissue formation. Elevated DHT has been associated with hair loss, decrease libido, acne and liver cysts. The good news is that there are ways to block estrogen during your treatment, but make sure to have a discussion with your doctor.
Some early studies had shown an increased risk in prostate cancer after taking replacement testosterone while more recently several studies have shown no increased risk of aggressive prostate cancer. While more studies need to be done these latest tests and growing studies are encouraging for men who need testosterone supplementation.
A potential issue is the male equivalent of female menopause (andropause). There is decreased production of testosterone or bioavailability of testosterone and a decrease in libido.
The reality is that irrespective of the approach taken, when you start a testosterone treatment program some of your testosterone will be converted to estrogen and some will be converted to DHT. For those who don't know, estrogen can have it's own not-so-fun side effects like increasing belly fat, impotence and female breast tissue formation. Elevated DHT has been associated with hair loss, decrease libido, acne and liver cysts. The good news is that there are ways to block estrogen during your treatment, but make sure to have a discussion with your doctor.
Some early studies had shown an increased risk in prostate cancer after taking replacement testosterone while more recently several studies have shown no increased risk of aggressive prostate cancer. While more studies need to be done these latest tests and growing studies are encouraging for men who need testosterone supplementation.