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By Chris Prakash, MD
Q: I am 45 years old, and recently went to my doctor because I was feeling exhausted. My testosterone level came out low. My doctor says that I might need testosterone shots. Do you think that is a good idea?
A: Before you start testosterone shots, it is important to know what is causing this problem. Here is what you need to know in a nutshell.
Low testosterone is called hypogonadism. This may be primary, where the testicles stop producing testosterone but the pituitary gland is okay, or it may be secondary to a problem with the pituitary gland. The pituitary gland is a gland in the brain that produces gonadotropins (FSH and LH) which in turn stimulate the testicles to make testosterone.
If your testosterone level is low (300 or less), I would recommend checking LH and FSH levels. If these levels are normal, that means that you have primary hypogonadism and can start testosterone replacement. However, if the levels of LH and FSH are low, you have secondary hypogonadism, and may need an MRI of the brain and Prolactin level to rule out a pituitary tumor.
You mentioned that you feel exhausted. That is a common symptom of low testosterone. You may also notice: Decreased sex drive, depressed mood, decreased sense of well-being, Difficulties with concentration and memory, erectile dysfunction, and fatigue and sleep disturbances.
So once you have established that you have low testosterone, the question is do you need replacement therapy? The effects of low testosterone can go unnoticed for years. The consensus is that if a man does not have any symptoms, he should not even be tested. There’s no proof that treating low testosterone in the absence of symptoms has any benefits. However, among men with symptoms, many of them will get a benefit from treatment. Men with symptoms of low testosterone can have significant impairment in quality of life, and it is these patients that should be treated with testosterone replacement.
There are several options available for testosterone replacement. These include:
Each of these options provides adequate levels of hormone replacement. Each has its own advantages and disadvantages. Intramuscular injections produce wider swings in hormone concentration, with higher levels shortly after the injection and lower levels just before the next injection is due. They may also produce increases in blood cell count that are higher than normal.
The body patches may produce skin irritation in a significant number of men, requiring discontinuation of the patch. The gels require care in making sure that the hormone is not accidentally transferred to another person or partner.
Notice that there are no pills available (may produce liver abnormalities and are to be avoided).
The choice of hormone replacement therapy is best made with a thorough discussion between you and your physician.
It is important to realize that testosterone replacement can have side effects. Some of the more common side effects are: Acne; Prostate stimulation (increased urination symptoms such as decreased stream or frequency); Breast enlargement; Decreased testicular size; Increase in red cell count; and decrease in sperm count, producing infertility (especially in younger men).
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.email@example.com