Low T Therapy Guide for Men
When testosterone levels decrease, many male body functions can be impacted. Sexual desire decreases, and bones and muscles weaken, among other problems that disturb men.
In the USA, approximately 18% of men over the age of 40, 20% of men over the age of 50, 30% of men in their 60s, and 50% of men in their 70s and older suffer from low testosterone levels. Different reasons can cause this, and we can take different measures to counteract it. Below, we offer a general explanation.
What is testosterone?
Although present in both men and women, testosterone is the dominant male sex hormone. It is a steroid hormone belonging to the group of androgens that plays an important role in developing male genitalia and secondary sexual characteristics.
95% of this hormone is produced in the testes, specifically in the Leyding cells, by a process known as “steroidogenesis” (manufacture of steroid hormones) regulated by the brain and the pituitary gland through LH (luteinizing hormone).
What is its function?
Testosterone has many significant functions even during embryo formation (before birth). It takes on special importance at 11-13 years with the onset of puberty, where its production increases, promoting:
- The development and growth of the penis, testicles, scrotum, and sexual secretory glands.
- The appearance of beard and body hair, deepening of the voice, growth of Adam’s apple or cricoid cartilage.
- Stimulates sperm production and thus the development of male fertility.
- Develops bone growth and prevents osteoporosis.
- Promotes the increase of muscle mass and strength.
- Increases libido and sexual desire.
Why does it decrease?
As the years go by, the testicles decrease their ability to produce testosterone. Aging is the principal cause of hypogonadism (low testosterone levels). In fact, after the age of 30-40, men lose up to 0.4-2% of testosterone annually. Other less common causes may be the use of certain drugs and certain diseases.
What symptoms are present?
When testosterone levels decrease, men manifest symptoms that may be subtle and not very noticeable or quite clear. Among them are:
- Low sexual desire (libido).
- Erectile dysfunction.
- Fatigue and low energy level.
- Decreased muscle mass.
- Smaller testicles.
- Sleep disturbances.
- Weight gain.
- Reduced bone density.
- Decreased ejaculation volume.
- Loss of body and facial hair.
- Difficulty concentrating.
- Low sense of well-being.
How can I increase my testosterone levels?
There are several natural methods to maintain normal levels. Physical exercise, especially resistance or weight-bearing exercise, adequate rest, a healthy diet, and good body weight, can help keep testosterone levels elevated.
But what happens when testosterone levels are abnormally low?
Medical specialists have developed special therapies for these cases that help raise and maintain normal testosterone levels. Low T therapy with testosterone may help reverse many the symptoms mentioned above.
There are different methods, each with its advantages and disadvantages. From injections to pills, we show you, their characteristics.
- Intramuscular injection
This has become a very common form of treatment. Sports people and athletes use it because it is the most potent replacement therapy. It comprises an intramuscular injection once or twice a week (to avoid the ups and downs of high doses). Go to a health professional for its placement, or they may teach you how to do it yourself.
It comes in an injectable solution (testosterone cypionate, enanthate, and undecanoate). Your healthcare professional will adjust your dosage according to your condition and reaction to the medication.
- Subcutaneous injection
Like the previous one, but this variation (testosterone enanthate or Xyosted) is administered on the left or right side of the abdomen (stomach), except in the navel and the area 2 inches around it, avoiding sensitive areas such as those with scars, tattoos or stretch marks.
- Transdermal gel
This gel is very easy to apply. It comprises applying once a day at the same time on the skin. By mimicking the natural release of the hormone daily, it allows for maintaining more stable testosterone levels. It dries quickly (a few minutes), but since it is transferable with skin contact with other people before drying.
- Nasal gel
Nasal testosterone has become an excellent replacement therapy because, unlike injections or transdermal gel, it does not suppress the hypothalamic-pituitary axis, preserving fertility by 95%.
Testosterone replacement therapies that suppress the hypothalamic-pituitary axis reduce sperm count and testicular atrophy, so we do not recommend them for those who wish to have children.
Its application is inside the nose 2 or 3 times a day along the edge of the nasal mucosa, so there is no risk of transfer to other people. Its negative effects may present rhinorrhea, nasal crusts, and epistaxis (bleeding from the nose).
- Transdermal patches
Applies preferably on the scrotum (sac containing the testicles) or close to it. For better absorption, the area must be free of hair, and the frequency of application will depend on the physician’s indications for each patient. It is commonly more spaced than the transdermal gel. To avoid skin irritation, you must rotate the site.
- Oral testosterone
This method is not the newest, but it is one of the most advanced and effective because of its improvements. They are easy to swallow and can maintain serum testosterone concentrations between 300 and 1000 ng/dL.
An important update on this replacement therapy is that the liver no longer metabolizes them; they now bypass this pathway, avoiding hepatotoxicity. They no longer require fatty meals to promote absorption into the intestinal lymphatic system, as the new oral testosterone formulations encapsulate a self-emulsifying drug delivery system containing, among other combinations, long-chain fatty acids, allowing absorption without food and improving efficacy and delivery.
- Buccal testosterone
It comprises a gum-adherent tablet that is absorbed through the internal mucosa of the cheek. It is applied twice a day, but the ingestion of food and beverages can interfere with the correct absorption, besides being prone to irritation.
- Testosterone pellets
They comprise small granules placed under the skin containing crystalline testosterone slowly released over 4 to 6 months, and they applied in the doctor’s office by your health professional since they are implanted under the skin. They usually place their measure at approximately 3 mm and near the hip.
Because their prolonged action usually requires two to four visits a year to the doctor’s office, which is beneficial for the patient since they do not have to worry about them for a long period. These pellets require a good implantation technique; otherwise, they are prone to infection.
What to expect from Low T Therapy?
Every man is different and, therefore, will respond differently. However, statistics report that many men show improvements in energy level, mood, sex drive and desire, the quality of erections, and muscle mass recovery with the corresponding help of physical activity.
Karen Herbst, MD, Ph.D., an endocrinologist at the University of California-San Diego, estimates that approximately one in 10 men is “ecstatic” with their response to testosterone therapy. Concluding that most have positive but variable responses to testosterone replacement.
However, like everything else, some health conditions prevent, according to experts, from performing this therapy; among them:
- Benign prostatic hypertrophy (BPH). Since the prostate grows naturally under the stimulation of testosterone, it could worsen with the therapy producing compression of the conduit that transports the urine (urethra).
- Prostate cancer as it may stimulate its growth.
- Sleep apnea.
- Blood clots. It could increase the risk of deep vein thrombosis and pulmonary embolism (a potentially fatal clot in the lungs), so do not overlook this warning.
- Congestive heart failure.
Low T therapy is individualized to each patient according to their requirements. Whether you require this therapy will be done through a blood test and based on your signs and symptoms. The best way to approach this condition is with the help of your physician, leading a healthy lifestyle, and relying on the therapy that is right for you.
It should be remembered that each therapy has its advantages and disadvantages, as well as each one is tailored to your needs and lifestyle. Nowadays, low testosterone levels are not a permanent problem because, with the right treatment, you will lead a life as you wish.
Finally, we remember that technology and science are advancing, and many of the medical treatments we know today are with it. Therapies have advanced and will continue to do so until better benefits and fewer consequences are achieved.