Testosterone Replacement Therapy: Injections, Patches, and Gels
Risks of testosterone replacement therapy in men
The RCTs of the effects of testosterone on cognitive function are limited and equivocal. Some studies reported improvements in verbal memory and visuospatial skill while others found no effect. In general, testosterone treatment of older hypogonadal men without cognitive deficit has not improved cognitive function (22, 23). In young hypogonadal men, testosterone treatment improves areal as well as volumetric BMD, trabecular architecture, and estimated bone strength. In the TTrials, testosterone treatment of older hypogonadal men increased volumetric BMD and estimated bone strength in the hip and spine more than placebo (21). None of the testosterone trials has been sufficiently long or large to determine its effect on fracture risk. Testosterone might also reduce fall propensity because of its effects on muscle strength and reaction time.
Low testosterone (male hypogonadism) is a condition in which your testicles don’t produce enough testosterone. It has several possible causes, including conditions or injuries affecting your testicles, pituitary gland or hypothalamus. The blood tests measure total serum testosterone, complete blood count (hematocrit), and prostate-specific antigens (PSA). People can expect to have these blood tests at the start of the treatment, then three to six months later. Doctors will then repeat these tests annually if the results prove to be stable. Past research found a correlation between TRT and lower urinary tract symptoms (LUTS) due to testosterone’s growth-promoting effects on the prostate. This is common among aging men who developed hypogonadism late in their life.
The deluge of advertisements marketing erectile dysfunction medications and testosterone products has empowered many older men to seek medical help for their sexual and genitourinary problems. Additionally, some of these medications are available in low-cost generic formulations. Disadvantages generally include less of a rise in testosterone levels compared to testosterone-containing therapies.
We monitor all of our TRT patients for rises in hematocrit, or blood thickness, as well as screening for potential prostate cancer every six months. In addition, TRT is not recommended for men who are currently trying to conceive, as active therapy can decrease sperm count and result in temporary sterility. We understand that this is a major concern for many of our patients, and that misconceptions about testosterone are rampant. But it’s important to consider that TRT is an FDA-approved treatment for a clinically-recognized disorder called "hypogonadism", where the testes produce inadequate amounts of testosterone, leading to adverse health effects. When taken responsibly under the guidance of a licensed medical professional who is appropriately evaluating patients and routinely monitoring blood work, TRT is considered to be very safe. Testosterone replacement therapy (TRT) is an effective long-term solution for the symptoms of does testosterone increase heart rate deficiency - fatigue, low mood, decreased libido, and decreased muscle mass among them.
That's why many men in their 70s and beyond can father children. "If men harbor any of the hallmark symptoms of low T and hypogonadism, I advise they meet with an andrology specialist for a thorough history and physical exam and to have their testosterone levels checked," says Dr. Muthigi. If you’ve felt any, or all, of these symptoms, we want you to know that you aren’t alone. Researchers estimate that over 38% of men aged 45 years or older may suffer from low testosterone levels, a significant contributor to all of the symptoms listed above.
Although testosterone might limit your fertility, you still can become pregnant if you have your uterus and ovaries and you have sex with a person who produces sperm. Talk with your healthcare professional about the form of birth control that's best for you. Besides, she adds, decreasing testosterone is a natural part of getting older — your doctor and their staff aren’t going to think you did anything wrong. It’s much more likely that they’ll just think you care about your quality of life.
However the risk of infection at the implant site and extrusion of the pellets which occurs in 5% to 10% of cases even with the most experienced limit their use. On average, someone can expect to spend between $100 and $450 per month on testosterone replacement therapy, depending on what kind, how much they need, and their health insurance coverage. Testosterone cypionate is the generic version of the brand-name prescription medication Depo-Testosterone. The cost for two vials without insurance is around $105, which is how much you would pay per month if your healthcare provider prescribed one injection every two weeks. Weigh up the risks of the treatment with the potential boost to your quality of life, and remember there are solutions out there if you’re concerned. With TRT, you take a manufactured form of testosterone to regulate your levels. This can help improve the symptoms of low testosterone, like low libido and lack of energy.
Guidelines from the American College of Physicians indicate that testosterone therapy might improve sexual function in some men, however, there is little evidence that it improves other functions, such as energy and vitality. The categorization of evidence strength is conceptually distinct from the quality of individual studies. By definition, Grade A evidence is evidence about which the Panel has a high level of certainty, Grade B evidence is evidence about which the Panel has a moderate level of certainty, and Grade C evidence is evidence about which the Panel has a low level of certainty. The Panel explicitly uses the term testosterone therapy rather than testosterone replacement therapy or testosterone supplementation to be in keeping with the beliefs of the current thought leaders in the field.
We don't give testosterone as a pill, because it can cause liver toxicity when it's metabolized through the gut. However, testosterone can be safely administered as a gel that you apply to your skin, injections that you give yourself at home, or as a pellet implant performed in the doctor's office. Your physician can help you determine which method is right for you. To minimize risk, the goal for people taking masculinizing hormone therapy is to keep hormone levels in the range that's typical for cisgender men — men whose gender identity aligns with their sex assigned at birth.
Before going to a testosterone replacement therapy clinic, do some research to find a reputable one. The prostate grows naturally under the stimulation of testosterone. For many men, their prostates grow larger as they age, squeezing the tube carrying urine (urethra).
