Testosterone is the hormone responsible for a man’s sex drive. When a man is diagnosed with low testosterone, also known as hypogonadism, he may experience low libido, lack of energy, erectile dysfunction, and other symptoms. Testosterone deficiency (Low T), affects two to four million men in the U.S. and the prevalence increases with age. It is estimated that while testosterone deficiency can affect up to 38 percent of the population, only five percent of affected men receive treatment.
Low testosterone has also been linked to metabolic syndrome (obesity, high blood pressure, diabetes, and high cholesterol) as well as decreased bone density, or osteoporosis.
Low testosterone is an often underdiagnosed condition in men because other psychiatric and medical conditions, as well as medications, can cause these same symptoms. The diagnosis of low testosterone should be considered if a man scores poorly on standardized questionnaires such as the Sexual Health Inventory for Men (SHIM).
A simple blood test to check for a testosterone deficiency, often administered in the early morning, is typically the first way to diagnose the condition. A general recommendation is that a testosterone level less than 300 is considered low. Low testosterone levels combined with clinical symptoms may warrant testosterone replacement therapy (TRT).
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.