Understanding Treatment Options for Testosterone Deficiency
Testosterone plays an important role in men’s health. It affects sex drive, muscle and bone health, red blood cell production and general wellbeing.
When testosterone levels are genuinely low, men can experience tiredness, reduced motivation, low libido, erectile difficulties, loss of muscle mass, increased body fat and problems with concentration.
None of these symptoms are specific to low testosterone though. Poor sleep, stress, excess weight, certain medications and other medical conditions can all cause similar problems, so a diagnosis shouldn’t be made on symptoms alone. It needs the right blood tests together with a proper clinical assessment.
If testosterone deficiency is confirmed, there are different ways of treating it. Which option is most suitable will depend on your symptoms, blood results, medical history and lifestyle.
What treatment options are available?
Testosterone replacement therapy comes in different forms, most commonly treatments applied to the skin and injectable preparations.
Topical treatments are usually applied every day and testosterone is absorbed through the skin. Some men find this easy and convenient, while others dislike having to apply treatment every day. Skin irritation can occasionally be a problem and absorption varies between people.
Injectable treatments are given at different intervals depending on the preparation. Some men prefer the convenience of not having to use treatment every day, while others may notice more variation in how they feel between injections.
There isn’t one form of TRT that is best for everyone. What works well for one man may not suit another, and sometimes the treatment needs changing or adjusting once you see how someone responds.
What needs to be monitored?
One of the things we look at during treatment is haematocrit, which is the proportion of the blood made up of red blood cells. Testosterone can increase red blood cell production and in some men this rises more than we would like.
Most people won’t notice this happening, which is why regular blood tests are important. If the haematocrit becomes too high, the testosterone treatment may need to be adjusted and other factors that could be contributing should also be considered.
Testosterone levels are monitored as well and, depending on age and individual circumstances, other checks may include prostate health, cardiovascular risk factors and any new symptoms or side effects.
Fertility
TRT suppresses the normal hormonal signals between the brain and the testes. As a result, sperm production can fall significantly and in some men may stop altogether while they are taking treatment.
If fertility matters now, or might matter in the future, this needs to be discussed before starting TRT as it may affect which approach is most suitable. There are also approaches that may be considered to help preserve fertility in some men.
Oestrogen
Men naturally produce oestrogen too, mainly through the conversion of testosterone, and it has important roles in bone health, sexual function and general health.
An oestrogen result that rises during TRT doesn’t automatically mean that something needs to be done about it. If someone develops symptoms such as breast tenderness or swelling, or their hormone levels become significantly abnormal, the sensible starting point is to look at the overall testosterone treatment, including the dose and how it is being given, rather than simply trying to change one number on a blood test.
Which treatment is best?
There isn’t a single answer. For some men a daily topical treatment works well, while others prefer injections. Sometimes the first treatment chosen needs adjusting or changing over time.
The aim of treatment isn’t to use the highest dose possible or to push testosterone levels as high as possible. It is to find a dose and treatment that improves symptoms where possible, gives appropriate testosterone levels and does so safely, with the fewest side effects.
Your symptoms, blood results, medical history, lifestyle, response to treatment and any plans for future fertility all form part of that decision.
Summary
Symptoms such as tiredness, low libido and reduced motivation are common and don’t necessarily mean testosterone is low, which is why proper assessment and blood testing come first.
If testosterone deficiency is confirmed, there are several ways it can be treated and each has its pros and cons. Treatment should be individualised to you and reviewed regularly.
If you are concerned about symptoms that could be related to low testosterone, speak to a doctor with experience in men’s health who can advise what investigations are needed and talk through all the options with you.
