Testosterone Replacement Therapy or TRT for short is used to treat the symptoms of low testosterone. As the primary male sex hormone produced and regulated through the HPTA (Hypothalamic-Pituitary-Testicular-Axis), it’s responsible for the proper functioning of male sex organs and plays a vital role in many of the male body processes. Testosterone Replacement Therapy treats the symptoms of hypogonadism or andropause by elevating the hormone levels back to the normal range. Let’s have a closer look at TRT, what it treats and how:
What Causes Low Testosterone Levels?
Generally speaking, problems with the HPTA can cause testosterone deficiency which manifests as hypogonadism. Primary hypogonadism occurs when there are issues within the testicles, and secondary hypogonadism originates from issues with the pituitary gland or the hypothalamus. Additionally, hypogonadism may not have a known cause and be idiopathic. These forms of hypogonadism may be caused by a range of medical or genetic issues, as well as lifestyle choices and environmental factors:
- Klinefelter and Kallmann syndrome
- Undescended testicles or testicular trauma,
- Pituitary disorders
- Cardiovascular problems
- Chronic illnesses
- Chronic stress
- Alcoholism or cirrhosis
- Inflammatory diseases;
- Cancer treatment
- Obesity and diabetes
- Mumps orchitis
Andropause — The Male Menopause?
Despite it not being such a prominent term in everyday speech, there is undoubtedly a hormone issue affecting aging males in similar ways as menopause affects women. Both of these conditions involve the decline of the primary hormone caused by age. Men affected by andropause may feel a loss of energy, decreased ability to focus and recall information, an increase in body fat, and a decrease in muscle mass, as well as a significant reduction in libido. The main difference between andropause and menopause is that menopause is quite sudden in comparison since andropause begins with a decline of testosterone production around the age of thirty and slowly progresses from there.
Main Symptoms of Andropause
Any male experiencing a testosterone deficiency will likely have some of the symptoms of andropause, but they also depend on the level of stress, amount of exercise, quality of nutrition and the number of toxins the individual is exposed to on a day-to-day basis. These symptoms include:
- Reduced lean body mass and a loss of strength
- Increased body fat
- Reduced bone density
- Low hemoglobin with mild anemia
- A decrease in energy levels and interest in one’s usual activities
- Atypical cholesterol values
- Loss of hair and a reduction in hair thickness
- Irritable Male Syndrome (IMS) — irritability, mood swings, anger, fatigue, depression
- Erectile dysfunction problems and decreased libido
Diagnosing Testosterone Deficiency
Diagnosing testosterone deficiency may take some time, and it typically takes a few steps. It starts with self-reporting, which includes evaluation of sexual function and secondary sexual characteristics. The standardized testing comprises an assessment of the current status of the patient’s energy, quality of life, mood, sexuality, and sleep. The analysis of historical information goes deeper into the patient’s personal, sexual and medical history. After that, blood tests and physical exams are performed to determine the diagnosis.
Testosterone Replacement Therapy Types
Treating the symptoms of low testosterone levels is possible with TRT. It approximates the average production of testosterone, which amounts to 4-7 mg of the hormone per day, with maximal levels in the morning. Ideally, TRT produces completely natural levels of testosterone without significant side effects.
There are three main types of testosterone preparations that are used in TRT: injectable, oral and transdermal forms.
The intramuscular injection or IM are administered via syringe directly into the muscle, and from there they are absorbed into the bloodstream through the capillaries. It allows for precise dosages and optimal time-release qualities which makes it a popular variation. It’s FDA-approved for treatment of hypogonadism.
The oral intake of testosterone is difficult to dose correctly in satisfactory concentrations. The liver quickly absorbs unmodified testosterone and modified testosterones like fluoxymesterone and methyltestosterone require large doses to be taken a few times per day. It creates a risk of hepatotoxicity, which is why it’s not recommended to use testosterone orally.
Transdermal or topical testosterone treatments are often in the form of gel or cream and absorbed through the skin after being applied topically. They’re also FDA-approved to treat hypogonadism and include the same benefits and possible side effects as the intramuscular injections: improvements in memory, energy, mood, and erectile function; an increase in strength, bone density and muscle mass along with a decrease in body fat. The side effects include gynecomastia, acne, vivid dreaming, night sweats, halitosis, increased appetite, and abnormal liver function test.
Usage of TRT and Monitoring
Even though testosterone replacement therapy can be extremely efficient both for young and aging men who experience a decrease in testosterone levels, it should be approached with due care and diligence. There should be continuous evaluation of the patient’s testosterone levels and hypogonadal symptoms, to ensure that the dosage is optimal and that there’ll be minimal side effects.
Men who have prostate and bladder conditions such as BPH (Benign Prostatic Hyperplasia), lipid abnormalities or cancer of the breast and prostate should steer clear of TRT. It’s also important to note that testosterone is not a substance to be treated lightly, considering that taking doses that are higher than those prescribed could cause adverse effects such as heart failure, heart attack, and stroke. Additionally, abuse of testosterone may cause depression, aggression, male infertility, liver toxicity, and hostility. It’s also possible to experience withdrawal symptoms from testosterone, so exercise caution, and immediately seek medical attention if you experience any symptoms such as shortness of breath, chest pain, slurred speech, or weakness in one side of the body.
Testosterone deficiency causes a range of issues such as hypogonadism and andropause, both in young and aging men. Treatment is possible with Testosterone Replacement Therapy, which aims to emulate the natural production of testosterone and fight the symptoms caused by andropause and hypogonadism. However, as with any medical therapy, caution and monitoring of the hormone levels are advised to avoid side effects.
Author: Kirill Vesselov
Kirill Vesslov is our resident writer about health and wellness as well as our pharmacy services.