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Low Testosterone

Understanding Low Testosterone (Low T)

Testosterone is a sex hormone produced by the testicles in response to natural signals that come from the brain. Testosterone surges during puberty allow for normal growth and development and play a critical role in supporting general and sexual health in adult men. Testosterone decreases naturally with age, but if levels drop quickly or below a certain level, a man can develop bothersome symptoms that significantly impact quality of life. Low testosterone can also make it difficult to lose weight, maintain muscle mass, and manage depression and diabetes.

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.

Symptoms of Low T

Common symptoms of low testosterone include:

  • Erectile dysfunction
  • Decreased energy
  • Decreased libido (sex drive)
  • Loss of muscle mass
  • Increased waist circumference (growing belt size)
  • Decreased exercise tolerance
  • Change in mental acuity or cognitive function
  • Irritability or mood change and/or depression
  • Mild anemia (iron deficiency)
  • Osteoporosis (brittle bones)

Diagnosing Low Testosterone

Low testosterone can be difficult to diagnose. Often, men have symptoms that they do not share with their doctors. Other times, symptoms are attributed to other health problems. Some of the symptoms of low testosterone are non-specific and may be related to other underlying health conditions.

Your provider will begin by taking your medical history and performing a physical exam. You will also receive instructions to complete blood testing to check the amount of testosterone and other hormones in your bloodstream. The timing of this blood work is very important since hormone levels change throughout the day. Your test results and your physical exam will help your urologist identify medical conditions that may be contributing to your symptoms and develop a personalized treatment plan.

Treatment with Testosterone Replacement Therapy (TRT)

If low testosterone has been diagnosed based on your symptoms and results of your blood test, your urologist will discuss Testosterone Replacement Therapy (TRT).

Treatment with testosterone may:

  • Increase energy
  • Increase sex drive
  • Improve erectile function
  • Increase muscle mass and improve bone density
  • Improve depression and fatigue

Testosterone replacement therapy (TRT) increases the amount of the hormone in your bloodstream and is administered in one of several ways:

  • Skin patches - A patch containing the hormone is applied to the body to deliver testosterone for 24 hours. The patch is changed daily.
    • Side effects: The patch may cause skin irritation at the site of application.
  • Testosterone gel - The gel is applied daily to either the shoulders, upper arms, thighs, underarm or intranasal area to deliver testosterone over 24 hours.
    • Side effects: Transfer of the gel to other people through physical contact is possible and could pose a risk. Contact with children and women (especially pregnant women) should be avoided.
  • Intramuscular injection- A short-acting dose of testosterone is injected every one to two weeks. A long-acting dose of the hormone can be used every 10 weeks.
    • Side effects: Home intramuscular injections produce greater fluctuations in hormone concentrations, which may also cause a swing in symptoms. These injections are also more likely to cause an increase in red blood cell counts compared to some newer formulations. Long-acting injections are administered in-office to monitor and limit the risk of very rare breathing symptoms.
  • Subcutaneous injections – An auto-injector testosterone therapy that can be self-injected at home once a week. Men report less pain at the injection site, the therapy is easier to travel with, and there is no need to handle needles. This therapy may take longer to become effective.
    • Side effects: Minor injection site reactions or irritation can occur.
  • Oral medication – A pill or pills taken once or twice daily which delivers consistent levels of testosterone safely, avoiding the liver issues caused by older and unregulated forms of oral testosterone.


  • Insertion of sub-dermal testosterone pellets – Small pellets containing testosterone are inserted beneath the skin, providing a slow release of testosterone into the body over time. This is performed in a 10-minute office procedure under local anesthesia every three to six months.

All forms of testosterone therapy can cause side effects (some are rare), including:

  • Increased red blood cells (polycythemia), which may predispose to clotting issues
  • Decreased testicle size
  • Decreased sperm production and infertility
  • Fluid retention
  • Nipple tenderness or puffiness (gynecomastia)
  • Possible BPH/enlarged prostate
  • Possible increased risk of heart attack and stroke

Is Testosterone Replacement Therapy Right for You?

In general, hormone replacement therapy is safe under the supervision of an experienced physician. Because testosterone replacement therapy may stimulate prostate growth, men who have been diagnosed with prostate cancer or are at increased risk of developing prostate cancer should be thoroughly evaluated by a urologist to determine whether TRT is recommended. Before beginning TRT, your urologist may perform a prostate exam and order a PSA blood test to assess the health of your prostate.

Every man reacts differently to testosterone replacement therapy, and symptom management and improvement vary. Your provider will work with you to monitor the benefits and side effects of TRT to ensure your overall good health.