Low Testosterone Treatment

Men age because of declining levels of hormones, not the other way around. The benefits of achieving optimal Testosterone levels are well established.  In fact, Testosterone Therapy is considered critical to men 40 years and above.

Health benefits are associated with “optimal” level of Testosterone, not “normal for age” level.  Optimal level of Testosterone means restoring the Testosterone levels to the top 25% of “normal” range. If the normal range is something like 300-1100 ng/dL, optimal level would mean 800- 1100 ng/dL.  In fact, men often need to get above 650ng/dL before they start feeling better.

Testosterone Therapy means replenishing someone with Testosterone using injectables, topical gel or cream or subcutaneous pellets implantation.  Another method is to inject HCG (Human Choriogonadotropin) subcutaneously.

  • Testosterone Injections
  • It has been used with significant benefits and minimal adverse effects.

    There are two long-acting injectables- testosterone cypionate and testosterone enanthate which can be used interchangeably.  Most doctors give Testosterone intramuscularly either in the buttock or in the thigh, either weekly or biweekly.  Subcutaneous injection has become popular in the last few years.  Patients often “felt” the effects of the treatment within days. Such results are certainly due to the higher blood concentration achieved with injections.

    The standard starting dose is 100mg every week. Depending on the individual response to treatment, dosage can be adjusted to higher amount at 150 – 200 mg per week.

  • Patches (Androderm)
  • With patches, men are freed from frequent visits to the doctor’s office.  Patches offered more uniform Testosterone concentrations, eliminating the roller-coaster effect that frequently occurs with injections.

    There are several problems:

  • Low therapeutic effects
  • Showing of a visible patch which may be awkward at times
  • Causing skin irritation as bright red round blotches at the location of the patches
  • Testosterone Gel
  • Testosterone gel is the most common form of treatment in the US.  It can be rubbed onto the non- hairy part of the upper arms, shoulders, side of abdomen or on the non-bearded area of the face, daily.  One should avoid bathing or showering in the first 2 hours of application, as well as avoid skin contact with the partners or children.

    Testosterone gel has good absorption. Nonetheless, about 15-20% of men do not absorb the gel well.  It is therefore imperative to check the levels to ensure an increased Testosterone levels.

    There are 2 types of gel: patented gel produced by big pharmaceutical companies and bio-identical gel prepared by specialized compounding pharmacies.

    Bio-identical Testosterone gel: In the wake of advancement in anti-aging medicine and the promotion of health via promotion of hormonally-balanced diet, better nutrition, exercise, herbal and dietary supplements, there emerges a preferred form of Testosterone called Bio-identical Testosterone or Natural Testosterone.

    Patented Testosterone produced by big pharmaceutical companies must be made “unique” before it can be “patented” and sold exclusively.  It is not to say that such “patented drug” is dangerous.  It is just not “natural” to the body’s Testosterone.  Bio-identical Testosterone, on the other hand is derived from plant and when absorbed into the blood stream, becomes identical to the Testosterone produced by our own body, molecule by molecule.  Its efficacy and safety are well established for over 15 years.

    In addition to being natural, Bio-identical Testosterone has two other advantages.  The physician can adjust the dosage according to the individual responses, and he can add other medicines to the mix with additional benefits which cannot be otherwise obtained from the fixed patented formula.

  • Testosterone pellets
  • Testosterone can be made into tiny grains called “pellets” that can be subcutaneously inserted just under the skin, preferably in the buttock area.  This surgical procedure is minimally invasive and the effect lasts on average 3-4 months.

    Advantages: Testosterone pellets deliver consistent, physiological levels of hormone.  There is no fluctuation of hormone levels compared with injections or gel.  Also, there is no excess conversion of Testosterone to Estradiol or DHT, the two metabolites that require monitoring.

    Most people feel a difference within 24-48 hours, while others may take up to 14 days.

    Possible complications may include: Extrusion <1-8% (hence the need to avoid early physical activity after the implantation); minor bleeding 0-2 minutes; minor infection 1-5%.

  • HCG
  • Subcutaneous injection of HCG can be used to stimulate the Leydig cells in the testicles to produce Testosterone. This option is particularly appealing to younger men who are concerned with the side-effects of testicular atrophy and reduced fertility.

    HCG can be used on its own or cycled with other forms of Testosterone Therapy to reduce these side effects.  This option may work if LH level is low or normal.