An estimated 13 million men in America have clinically low testosterone levels, and fewer than 10% of these get treatment for it. Symptoms of low testosterone include low libido, fatigue, difficulty in concentration or memory, depression, loss of muscle mass, and difficulty in losing belly fat. One of the most common complaints that men with low testosterone have is that Viagra, Levitra, or Cialis no longer work in treating their erectile dysfunction (ED). There are a number of causes for men to have low testosterone levels, including side effects to medications, (antidepressants and chronic narcotic pain medication), history of viral infections (hepatitis, HIV, polio), steroid abuse for bodybuilding, history of chemotherapy, and exposure to environmental estrogens. A testosterone blood test is ordered to confirm that a low testosterone is the culprit in causing the man’s symptoms.
Treatments for low testosterone are tailored to the patient’s preferences and insurance coverage, and include oral testosterone boosters, testosterone injections, topical gels and creams, and testosterone pellet implantation. Follow up blood testing is performed to document that the free and total testosterone levels are in the normal range. TRT causes very few negative side effects. Potential negative side effects of TRT are monitored by periodically testing the patient’s PSA, estradiol level, and hemoglobin and hematocrit.
TRT is as much an art as it is a science, and the urologist is the specialist who is uniquely trained in diagnosing, treating, and monitoring patients with this common and bothersome condition.