Low Testosterone

Low testosterone has become a controversial topic, and misinformation about low testosterone and testosterone treatment abounds. However, expert and affordable care for men who have low testosterone is within reach at MetroWest Urology.

Low testosterone has become a controversial topic in recent years, sometimes leaving patient’s without a clear understanding of their condition and treatment options.

At Metrowest Urology, our physicians are nationally recognized experts in the field. We aim help out patients understand how testosterone influences their health and life goals and provide safe, effective, and affordable treatment.

Our Experts

Our physicians have had a front row seat as testosterone has become a controversial topic in recent years. Our research has influenced FDA opinion and national guidelines on treatment of low testosterone and we have been key players in the development of novel treatment approaches. We use our insight gained from these experiences to help our patients clearly understand their individual condition and the optimal treatment options for them.

Dr. Conners is on the Executive Committee of the Sexual Medicine Society, a leading group that publishes guideline for the treatment of low testosterone and has published and lectured extensively in the field. Dr. Kacker is a leading researcher on the influence of testosterone and metabolism and made a key finding of a statistical error in a widely reported study which, incorrectly, implied that testosterone can increase risk of heart attack and stroke. Dr. Kacker is involved in the development of new therapies to treat low testosterone and is the inventor and driving force behind AndroSphere, a new approach currently being developed with a team of international pharmaceutical companies.

What is Low Testosterone

Testosterone is the main hormone produced by the testicles. Testosterone plays an important role in the regulation of Mood, Metabolism and Sexual Function. Men with low testosterone may suffer from symptoms or health issues in one of more of these areas:

Domain Symptoms Related to Low Testosterone
Mood
  • Lack of motivation/drive
  • Depression
  • Labile Mood/Short-Fuse
Metabolism
  • Low bone density (osteopenia or osteoporosis)
  • Insulin Resistance and Propensity for Diabetes
  • Weight Gain/Difficulty losing weight with diet and exercise
  • Loss of muscle mass/strength
  • Low Energy/Loss of Endurance
Sexual Function
  • Erectile Dysfunction (particualry morning erections)
  • Difficulty reaching Orgasm/Climax
  • Decreased Ejaculate Volume
  • Decreased Penile Sensitivity

Some men with mildly low testosterone may have very few of these symptoms. However, other men with more severe low testosterone may have several symptoms in multiple domains.

Low testosterone is often diagnosed on the basis of low testosterone level son blood tests (biochemical low testosterone). While many insurance policies and other guidelines use strict blood test to define low testosterone, the true condition is far more complex. The amount of testosterone that one man needs may be very different from another man, due to differences in the ability of the body to access and use testosterone. Some men who may have low blood tests do not actually have any signs or symptoms of low testosterone and may not need to be treated. Conversely, some men may have testosterone levels in the normal range but actually be functionally lacking in testosterone and benefit from treatment.

Why Do Men Develop Low Testosterone

While testosterone is produced by the testicles, only roughly 10-20% of low testosterone occurs due to failure or loss of the testicles. The majority (80-90%) of testosterone has to do with the pituitary gland. Normally, the pituitary gland controls production of testosterone by sending signals every hour or two to the testicle to tell it to product testosterone. Lack of pituitary signaling (sometimes called secondary hypogonadism) is the most common cause of low testosterone

Testosterone levels, on average, do decrease with age, low testosterone is not an inevitable part of aging. In fact, as many men age the pituitary gland can increase its stimulus to the testicle and compensate for slowing of the function of the gland. Low testosterone due to insufficient signals form the pituitary can occur in men of any age due to drugs/medications, sleep disturbance, health problems, or other factors.

How Is Low Testosterone Treated

Several companies and clinics take advantage of the controversies around and offer expensive, and often unnecessary, treatment protocols and supplements. Fortunately, there are several affordable or insurance covered options.

The most common treatment for low testosterone is to administer more testosterone. This can come in the form of a gel, injection, intranasal gel or implantable pellet. Testosterone is not currently available in a safe oral pill or tablet. The optimal type of treatment is an individual decision, based on levels and goals of treatment.

Testosterone may also be treated by stimulating the testicles to produce more testosterone. The most effective way to achieve this is to treat with hCG (human chorionic gonadotropin). hCG has the advantage of maintaining fertility and testicular activity, but can involve several injection per week. Clomiphene citrate is a more convenient oral treatmen that can also increase testicular testostoerne production. Clomiphene citrate, however, modulates estrogen and can have highly variable effects. In general, it is not as effective at improving symptoms and health effects of low testosterone compared to testosterone itself or hCG.

Is Testosterone Therapy Safe?

Like all medical treatments, testosterone therapy has both risks and benefits. A judicious treatment plan involves minimizing and monitoring for risk while optimizing benefits.

All formulations of testosterone lead to infertility and testicular atrophy. Some men may also experience acne/oily skin, breast symptoms, acceleration of male pattern baldness, and increase in red blood cell count. Certain forms of testosterone therapy can lead to fluid retention, which is often temporary.

Historically, there have been concerns around testosterone and prostate health, although our current understanding shows that testosterone does not seem in crease risk of prostate problems or prostate cancer. More recently, concerns have been raised that testosterone may increase the risk of heart attack and stroke. However, the vast majority of research on testosterone shows that it is safe and may even be beneficial in avoiding cardiovascular disease. Our physicians at Metrowest Urology can help discuss these controversial issues in detail and in the context of your individual health

Learn More – Click here for a copy of Dr. Kacker’s Presentation – Testosterone: Current Opinion and Controversy