Services Information

THE IMPORTANCE OF TESTOSTERONE

What is testosterone?

Testosterone is the predominant male hormone that affects sexuality and metabolism. The normal progression of testosterone levels of men levels out around the ages of 18-23 years old than continues to slowly decline as we age. Eventually, men's testosterone can decline below a threshold that causes symptomatic, low testosterone (hypogonadism). These symptoms include decreased libido, decreased energy, decreased mood, among other generalized, non-specific symptoms. Sometimes, there are certain environmental factors that can cause a sharper decline in the testosterone than the average person. Since testosterone stores are replenished during deep sleeps, someone who has repeatedly interrupted sleep cycles, such as shift workers (fireman, policeman, etc.) may have decreased levels at an earlier age. Other factors that cause this sharper decline include obesity, high stress, labor, certain foods, etc.

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Treatment and Monitoring

 A significantly low testosterone would be a total testosterone below 350. Initially, we will check total testosterone and prostate labs. With a qualifying lab, a patient receives a low dose injection of testosterone cypionate weekly. Labs are rechecked a month later to see if total testosterone is at goal (patient specific), where the dose is adjusted from there, and estrogen, to make sure that the testosterone is not converting to estrogen. Labs are checked again at 3 months to check complete blood count, comprehensive metabolic panel, cholesterol panel. If everything is stable at that point, then we continue weekly injections and monitor labs every 3-6 months.

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Side Effects                                                                                                                Side effects of testosterone therapy are rare but do occur.

1. Acne -The most common rare side effect of testosterone therapy is acne, which tends to affect only chest, back and shoulders.

2. Gynecomastia - Another side effect is gynecomastia, due to normal aromatization of testosterone into estrogen. If this occurs with a normal dose of testosterone, we may have to give an extremely low, weekly dose of Arimidex, which blocks the conversion of testosterone into estradiol. With this added to the therapy, gynecomastia is virtually eliminated.

3. Low Sperm Count - Another side effect is decreased sperm count and testicular atrophy, caused by the slowing down of the negative feedback mechanism from the pituitary to the testicles due to the consistent levels of exogenous testosterone. Intermittent Gonadorelin every 6 months is useful as part of testosterone replacement therapy to "trick" the pituitary into sending LH and FSH to the testicles to prevent atrophy.

4. Contraindicated with History of Prostate Cancer - A prostate lab is checked initially and more frequently to monitor levels due to the contraindication of testosterone replacement therapy with history of prostate cancer. Testosterone therapy does not cause cancer, but if there was already cancer present, increased testosterone levels in the blood may potentially cause growth level to increase.

5. Water Retention - Mild water retention is another rare side effect that, usually, occurs with initial onset of therapy, especially with increased activity (weightlifting), but tends to last only one to two months. If bothersome, a mild diuretic may be indicated.

6. Polycythemia - The rarest of side effects of testosterone therapy is polycythemia, which would be monitored with a CBC every 6 months.

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All labs and medications are included with our service. With proper monitoring and management, you can have a much better quality of life with testosterone therapy.