Treatment for Low Testosterone

Testosterone is the primary male reproductive hormone, which regulates several functions in the human body such as maintenance of secondary sexual characteristics, facial hair growth; development of testes, deepening of voice etc. Low testosterone levels in male is a common issue that affect millions of males around the world. The testosterone decline can be easily confirmed via simple blood hormonal assay. The characteristic symptoms of low testosterone levels include (1):

• Decreased muscle mass
• Anxiety and depression
• Erectile dysfunction
• Loss of sex drive
• Decreasing Libido etc.
• Insulin resistance

Fortunately, low testosterone levels can be adequately managed via several therapeutic options such as testosterone replacement therapy to restore the normal quality of life.

Goals of Testosterone Replacement Therapy

The major aim of testosterone replacement therapy is to normalize the serum levels of testosterone, which ranges between 300-1000ng/dl (nanograms per deciliter). Replacing the testosterone from external supplemental sources can help in the regulation of desired bodily functions. However it should be kept in mind that testosterone replacement therapy is not a solution to delay aging or improving athletic activity. A physician should only prescribe this therapy, if the person is diagnosed with low levels of testosterone.

Testosterone Replacement Therapy Options

Hormone replacement therapy can be administered via number of methods; such as testosterone gels, patches, or injectables.

The therapeutic efficacy, bioavailability and drug dynamics vary depending upon the route of administration. Therefore, the route of administration should be ideally decided after weighing pros and cons.

1. Testosterone replacement Via Injections

Two formulations are available as injectable namely Delatestryl, which contains testosterone enanthate as active hormone and Depo-testsoterone that contains testosterone cypionate as active compound.

• Advantage: They are relatively inexpensive. In addition, the injection needs to be injected only once a week (or once in two weeks)

• Disadvantage: The appropriate management of serum testosterone is difficult to control; the levels may appear too high just after the injection and loo too low when next one is due.

2. Testosterone Replacement Gels:

Testim and Androgels are two of the available testosterone gel formulations. The gel must be applied on the skin of shoulders or arms at the same time, every day.

• Advantages: Use of testosterone gel is known to effectively control testosterone concentration in the serum; it is one of the most convenient methods because it is non-invasive, with a fairly high patient compliance rate.

• Disadvantages: They are relatively expensive products.

Gel application can often result in skin irritation in people who have sensitive skin.

3. Testosterone Replacement via Patch:

One of the available testosterone patches is Androderm; this patch must be applied on skin every night and should be left on skin for 24 hours. The site for application of patch should not be too hairy such as abdomen, back, lower side of arm etc.

• Advantages: Application of testosterone patches provides consistent levels of testosterone in blood.

• Disadvantages: In sensitive persons the patch may cause serious irritation and itch.

Tablet under upper lip

Buccal tablet available with the name of Striant, needs to be placed under the upper lip along the gums so that the testosteroneenters in the systemic circulation (bypassing hepatic metabolism. The tablet must not be swallowed in stomach and should be replaced after 12 hours.

• Advantages: As it enters the systemic circulation, it provides consistent levels of testosterone in blood.
• Disadvantages: It has a bitter taste and can also cause gum irritation.

Side effects of Testosterone Replacement Therapy

Regardless of the route of administration, the risk of certain adverse effects is fairly high in individuals who consider testosterone replacement therapy; these are:

• Swollen or tender breasts
• Increased frequency of urination
• Weight gain
• Shortness of breath
• Sleeping issues
• Acne

Cautions Associated with Testosterone Replacement

Although the success rate of testosterone replacement treatment is very high, there are some cautions and concerns as well. Healthcare professionals advice that this therapy should not be considered by individuals who are suffering from prostate cancer, breast cancer and other malignancies responsive to hormones. Blood examination is also done so that red blood cell count can be evaluated since testosterone therapy may affect the production of red blood cells. Likewise, individuals with pre-existing blood disorders (such as polycythemia or abnormally high hematocrit) are not good candidates for testosterone therapy.

Low testosterone is a medical condition that demands careful evaluation of causes and optimal management to ensure normal quality of life in affected individuals.

References

1. Grossmann, M., Thomas, M. C., Panagiotopoulos, S., Sharpe, K., MacIsaac, R. J., Clarke, S., ... & Jerums, G. (2013). Low testosterone levels are common and associated with insulin resistance in men with diabetes. The journal of clinical endocrinology & metabolism.

2. Matsumoto, A. M. (2013). Testosterone administration in older men. Endocrinology and metabolism clinics of North America, 42(2), 271-286.

3. Dinsmore, W. W., & Wyllie, M. G. (2012). The long‐term efficacy and safety of a testosterone mucoadhesive buccal tablet in testosterone‐deficient men. BJU international, 110(2), 162-169.