Low testosterone level: what is hypogonadism and how to treat it; Low T therapy and risks of TRT

1. Testosterone Therapy
Risks and Benefits
By Dyer, Garofalo, Mann & Schultz L.P.A.

2. Testosterone
¡ Even though testosterone is usually associated with men,
but this androgen hormone is produced both in males’
testicles and females’ ovaries. Testosterone belongs to a
class of male hormones called androgens. But women
also have testosterone.
¡ In general, testosterone effects the body in two ways:
¡ Anabolic effects: growth of muscle mass and strength,
increased bone density, etc.
¡ Androgenic effects: maturation of sex organs, stimulates hair
growth, bone growth, libido, and oil production in the skin and
hair.
¡ In males, it’s behind facial, chest, arm, and leg hair
growth. It causes the voice to deepen and the Adam’s
apple to grow. In adult males, testosterone is required for
sperm production, aids in maintenance of muscle mass,
and affects the clotting properties of the blood.
Image credit and license

3. Why Do We Need Testosterone?
¡ Both men and women will benefit from
maintaining adequate levels of testosterone,
which improves both mental and physical well-
being.
¡ Testosterone increases both muscle strength and
bone density, and helps to decrease fat mass.
¡ A healthy testosterone level is necessary for
healthy sexual arousal in both sexes.
¡ Testosterone affects brain chemistry and
function, especially memory, attention, and
spatial relations.

4. Hypogonadism
¡ Hypogonadism, or androgen deficiency, is a
medical term which describes a diminished
functional activity of the gonads – the testes and
ovaries in males in females. In other words, this is a
condition when the body doesn’t produce enough
testosterone.
¡ Hypogonadism may be caused by:
¡ a number of diseases,
¡ environmental factors,
¡ health issues such as poor nutrition or obesity,
¡ chronic alcoholism, or
¡ defects in the pituitary system or hypothalamic system.
¡ It may be inherited or acquired later in life.

5. Male Hypogonadism
¡ It is common for men to experience naturally
declining testosterone levels after they age.
¡ Testosterone usually peaks around age 30 and
decreases about 1% per year thereafter.
¡ The body’s testosterone level can decline due to
health concerns such as obesity and alcoholism,
and it may be reversible through behavioral
changes.
¡ Types that stem from syndromes or genetic
conditions may be irreversible and require
hormone supplements.

6. Male Hypogonadism (cont.)
¡ Symptoms of hypogonadism in men may include:
¡ enlargement of the breasts,
¡ degradation of muscle mass,
¡ reduced body and facial hair, and
¡ decreased libido.
¡ Androgen deficiency may cause osteoporosis,
infertility, and fatigue.
¡ Men with low levels of testosterone may also
experience hot flashes and fatigue and have
difficulty concentrating.

7. How To Treat Hypogonadism?
¡ Male hypogonadism is generally treated by
testosterone replacement therapy (TRT).
¡ Testosterone therapy can take three form
¡ Testosterone gels
¡ Gels must be applied to the skin on arms or shoulders
about the same time every day.
¡ Testosterone Injections:
¡ It should be taken one every one or two weeks and is
relatively inexpensive.
¡ Transdermal patches:
¡ Patch is applied to the skin each night and left in
place for 24 hours.
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8. How To Treat Hypogonadism?
¡ Historically, testosterone was delivered in a form of
tablet that was placed under the upper lip.
¡ However, that treatment was ineffective, because
the liver breaks down the testosterone before it can
get to the blood stream. It could also cause severe
liver damage.
¡ Many different pharmaceutical companies offer TRT
products that use hormones, which almost perfectly
chemically match the testosterone that you
produce naturally.
¡ These companies include Striant, Delatestryl,
Androderm, AndroGel, Testim, Axiron, and Fortesta.

9. Low T
¡ Condition of having slightly lowered testosterone
levels is often referred to as “Low T.”
¡ Slightly lowered testosterone levels are a natural
part of aging.
¡ Being overweight may also cause lowered
testosterone levels; a host of diseases may do the
same.
¡ Older men are more likely to be overweight and
more prone to contracting diseases, which can
exacerbate the natural decrease in testosterone.
¡ Some experts suggest that decreasing testosterone may
be attributable more to these external factors than to
the aging process

10. Low T (cont.)
¡ While it’s necessary for patients with severe
hypogonadism to use TRT to alleviate neurological
symptoms and prevent degeneration of bone and muscle
tissue, “low T” patients often seek TRT in order to boost
their energy and mood.
¡ Some patients look to TRT to treat erectile dysfunction (ED)
as well; ED is another common issue associated with
aging.
¡ While some “low T” patients do report improved sexual
health and energy, results of the clinical studies were
mixed.
¡ The fact that many patients who take TRT for “low T”
treatment are not actually hypogonadal at all further
complicated the study of TRT’ effects.

11. Low T Products
¡ More than 30 different Low T products
are available on the market. Some of
the most common are:
¡ Androderm
¡ Androgel
¡ Delatest
¡ Depo-Testosterone
¡ Duratest
¡ Fortesta
¡ Striant
¡ Testim
¡ Testoderm

12. TRT Risks
¡ Deep vein thrombosis is the one of the most serious
side effects associated with TRT.
¡ Deep vein thrombosis: formation of a blood clot in a
vein deep in the patient’s leg; that clot can break
up or break free and travel to the lungs.
¡ There, it can block blood flow to the lungs, causing
serious lung damage and even death.
¡ Increased risk of heart attack is associated with TRT.
¡ Studies indicate that “low T” patients taking a
testosterone supplement are up to 30% more likely to
have a heart attack or stroke within the next 3 years
than their “low T” counterparts who do not take
supplements.

13. TRT Risks (cont.)
¡ Other major side effects of TRT include, but are
not limited to:
¡ sleep apnea (a condition in which breathing stops
and starts while the patient sleeps)
¡ Enlarged breasts of male patients,
¡ Decreased sperm production
¡ Testicles shrinkage
¡ Excessive body hair
¡ Deepening of the voice in women and children
¡ Early puberty in children.

14. TRT Risks (cont.)
¡ TRT can stimulate the growth of existing prostate
cancer and can cause prostate growth in
patients without prostate cancer.
¡ Minor side effects include acne and weight gain.

15. Is it worth the risk?
¡ TRT is required for those individual suffering from
severe hypogonadism to maintain bone and
muscle mass and to avoid neurological
complications.
¡ “Low T” patients are not at risk for those conditions
and are typically seeking TRT as a remedy for low
energy and decreased sexual function.
¡ Due to the lack of conclusive evidence to support
“low T” treatment’s effectiveness and a high
number of risks associated with TRT, several medical
research organizations, including Mayo Clinic,
advocate against using TRT to treat aging-related
symptoms.