Hypogonadism is a condition in which the body doesn't produce enough testosterone — the hormone that plays a key role in maintaining a man’s energy level, sex drive (libido) and erection quality.
Dr. Steinberg will order the measurement of morning total and free testosterone blood levels which can help establish the diagnosis of hypogonadism. LH and FSH are specialized blood tests which are ordered to determine whether the problem arises from the testicle or from abnormal brain hormone levels. To further clarify the cause of hypogonadism, further hormonal testing such as serum prolactin, thyroid function tests and sex hormone binding globulin levels may be ordered.
Testosterone gel is mainly used as a first line treatment for low testosterone in men. Common testosterone gels include Androgel, Foretesta and Testim. Testosterone gel is a less invasive method than injections, with the man rubbing the gel onto the shoulders or upper arms once daily. Testosterone gel usually dispenses in either packet or pump form and is generally clear and colorless. If testosterone levels are low, Dr. Steinberg will customize a dosage and type of testosterone gel for you depending upon the results of your lab tests.
Testosterone may also be given by a deep muscular injection every 2 weeks. Dr. Steinberg will instruct the patient or his partner on the technique of drawing up the medication and injecting it into the arm, thigh or buttock. As with any form of testosterone supplementation, Testosterone levels, complete blood count and prostate specific antigen levels need to be monitored on a regular basis.
Dr. Steinberg performs Testosterone implants in the form of small pellets (Testopel), which slowly deliver testosterone over the course of three to six months. During a 15 minute office procedure, the testosterone pellets are implanted under the skin in the buttock using local anesthesia and gradually dissolve over a few months. This testosterone delivery method gives a slow, steady constant infusion of testosterone into the body.
Treatment with Testosterone Replacement Therapy (TRT)
Accepted methods of TRT in the United States include:
- Skin patches
- Topical gels
- Injectable medications
Oral testosterone medications are currently not FDA-approved due to potential liver toxicity. Your testosterone level and other factors will determine which therapy is used. Testosterone treatment can decrease sperm counts and even render men sterile (which is usually reversible), so men desiring fertility should be given alternative medications to help boost their own natural testosterone levels. Testosterone replacement therapy should never be used in men desiring fertility, and other treatments may be indicated such as an aromatase inhibitor or HCG.
TRT requires close monitoring for changes in blood count, prostate-specific antigen (PSA) level, and liver enzymes. This blood testing should take place two to four times per year, and a digital rectal examination in needed every six months for prostate cancer screening.
Treatment of Low-T
Treatment of Low-T in men is done through a process called Testosterone Replacement Therapy (TRT), which treats declining levels of testosterone as men get older.
Intramuscular testosterone injections - Injections will occur roughly every two weeks, depending on the diagnosis. Testosterone is directly injected into the muscle, which delivers testosterone through the bloodstream, and alleviates symptoms of low testosterone.
Transdermal gels/patches - The gel or patches are applied to the arm or upper body. They deliver testosterone to the body through the epidermis (skin). A testosterone patch may be prescribed when injections aren’t convenient or preferred by the patient.
Testosterone gels - Applied once a day topically, directly onto the skin. Gels absorb the testosterone through the skin for easy delivery.
Testopel - An office procedure involving testosterone implants placed directly into the subcutaneous tissue, which allows for a slow, steady release of testosterone into the endocrine system. This procedure, once initiated, is required every four to six months.
Clomiphene citrate - This drug is most often prescribed to patients with low testosterone who are trying to conceive.