What Is Low Testosterone and What Causes It? Richmond University Medical Center

Low Testosterone: Causes, Diagnosis & Treatment

Due to pituitary suppression, these men often do not respond well initially to SERMs or anastrazole, and going straight to HCG is sometimes the best choice. Men without a functional pituitary (e.g. prior pituitary surgery or radiation) are not going to respond to the use of SERMs either. When a man’s testosterone hormone level is low, it can reduce his sex drive, and cause both irritability and erectile dysfunction. Low T may also cause weight gain, fatigue, decreased muscle, and increased body fat.

Similarly, in the event patients have unexplained anemia that improves on testosterone therapy, continuation can be considered even in the absence of other symptom improvement. Testosterone replacement may improve your sexual desire, increase your muscle mass, and help prevent bone loss. Many men with low testosterone levels report that they feel better and have more energy while taking testosterone.

In males, hypogonadism, a condition where the testicles produce little or no testosterone, may occur at any age. A diminishing sex drive occurs naturally with age, but when the cause is low testosterone, a male will notice a significant decrease in the desire for sex. Primary hypogonadism happens when something is wrong with your testicles that doesn’t allow them to make normal levels of testosterone. Any issue with your testicles, hypothalamus or pituitary gland can testosterone cause cancer cause low testosterone (male hypogonadism). Seeing a specialist, such as a urologist, is the best way to find testosterone-boosting solutions that will work.

In some men, estrogen levels will increase as testosterone levels increase. Men naturally need some estrogen, one of the main sex hormones that women have, in the body for bone health and other body functions. But too much estrogen can cause conditions such as gynecomastia (male breast tissue).

Patients on short-acting IM or short-acting SQ pellets (testosterone cypionate or enanthate) should have their testosterone measured after several cycles such that testosterone level equilibration has been achieved. The Panel recommends that this be completed no earlier than three to four cycles. While no data exist on the optimal timing of the blood draw within a cycle, it has historically been recommended that blood draws be conducted mid-cycle. The main driving force behind such a strategy is convenience for patients and clinicians, although such timing has no ability to define peak and trough levels. In addition to issues relating to the reliability of compounded products themselves, appropriate clinical studies on pharmacokinetics are lacking. As such, even if consistent testosterone levels could be achieved, providers issuing prescriptions for compounded testosterone need to consider performing additional monitoring and dose adjustments to ensure appropriate therapeutic levels. There are limited data in men on active surveillance who are candidates for testosterone therapy.

Testosterone replacement therapy may contribute to or cause sleep apnea. Sleep apnea is a serious medical condition that causes your breathing to stop and start repeatedly while you sleep. It can disrupt your sleep pattern in the process and raise your risk for other complications, like having a stroke.

Given the increasing incidence of both testosterone deficiency and prostate cancer with advancing age, it is common for the two conditions to co-exist in older men. Generally, clomifene does not have adverse effects at the doses used for this purpose. Results of the trials assessing cognitive function, anemia, bone density, and cardiovascular health are forthcoming. However, the Testosterone Trials were designed to assess only effectiveness and not the risks of testosterone therapy, including prostate cancer or cardiovascular disease. Low testosterone levels in males can lead to erectile dysfunction.

Some doctors may prescribe testosterone off-label to females to improve libido, but this use has not been approved by the Food and Drug Administration (FDA). If you are taking hormone replacement therapy, regular follow-up appointments with your physician are important. As a man ages, the amount of testosterone produced in his body gradually drops.

The physician is encouraged to carefully follow all available prescribing information about indications, contraindications, precautions and warnings. These guidelines and best practice statements are not in-tended to provide legal advice about use and misuse of these substances. Although guidelines are intended to encourage best practices and potentially encompass available technologies with sufficient data as of close of the literature review, they are necessarily time-limited. Guidelines cannot include evaluation of all data on emerging technologies or management, including those that are FDA-approved, which may immediately come to represent accepted clinical practices. For this reason, the AUA does not regard technologies or management which are too new to be addressed by this guideline as necessarily experimental or investigational.

There are several areas in the testosterone deficiency space, more specifically, epidemiology, diagnosis, treatment and adverse events, which warrant more detailed investigation. Patients who are on long-acting IM testosterone (testosterone undecanoate) should have blood work tested once steady state levels have been achieved. Testosterone undecanoate is typically re-administered at a time point 4 weeks after initial dosing and then every 10 weeks thereafter. As with short-acting IM testosterone injections, the general recommendation is mid-cycle testing, after equilibration, and halfway between the first two 10-week injections. Table 6 (featured below) provides pharmacologic information for SERMs, hCG, and AIs.