Testosterone replacement therapy (TRT)

The role of testosterone in the male body:

Testosterone is a hormone produced primarily in the testes. For men, testosterone helps maintain the following

  • Bone density
  • Fat distribution
  • Muscle strength and mass
  • Red blood cell production
  • Sex drive
  • Sperm production

Testosterone peaks during adolescence and early adulthood. As you get older, your testosterone level gradually declines — typically about 1 percent a year after age 30.

Testosterone levels decline naturally with age, this decline may cause:

  • Changes in sexual function. This may include reduced sexual desire, fewer spontaneous erections — such as during sleep — and infertility.
  • Changes in sleep patterns. Sometimes low testosterone causes insomnia or other sleep disturbances.
  • Physical changes. Various physical changes are possible, including increased body fat, reduced muscle bulk and strength, and decreased bone density. Swollen or tender breasts (gynecomastia) and hair loss are possible. You may experience hot flashes and have less energy than you used to.
  • Emotional changes. Low testosterone may contribute to a decrease in motivation or self-confidence. You may feel sad or depressed, or have trouble concentrating or remembering things.

Contributing factors to the development of androgen (testosterone) deficiency include: 

  • Medications, especially those used to treat depression or mental disorders
  • Alcoholism
  • Chemotherapy or radiation treatment for cancer that targets or harms the testicles
  • Chronic illness
  • Dysfunction of the pituitary gland (a gland in the brain that produces substances that regulate hormone production from the brain to the testis)
  • Hemochromatosis (too much iron in the blood)
  • Hypogonadism (when the testis is not able to produce high enough levels of testosterone, aka androgen deficiency, or sperm, aka spermatogenesis)
  • Inflammatory diseases, such as sarcoidosis (a condition that causes injury to or infection of the testicles)
  • Illnesses, such as AIDS, that compromise the immune system
  • Excessive stress, which taxes the adrenal system

Symptoms of testosterone deficiency

  • Erectile dysfunction (the inability to get or maintain an erection)
  • High cholesterol levels (having high cholesterol or high blood pressure causes hardening of the arteries, which can decrease blood flow to the testicles and cause enough damage to lower testosterone)
  • Obesity, especially around the waist
  • Depression
  • Anxiety or mood swings
  • Problems with concentration and memory or other cognitive and intellectual functions
  • Low sex drive
  • Decreased bone density, possibly leading to osteoporosis

Treatment and Management of testosterone deficiency

 Testosterone Replacement Therapy (TRT).
The treatment is usually long-term and should only be started when androgen deficiency has been clinically proven, including testing hormone levels in the laboratory and ruling out other possible medical conditions.Testosterone is available in pill form, patches, gels, creams, and intramuscular injections or it can be implanted under the skin. Absorbing testosterone through the skin via a patch or gel or receiving an intramuscular injection (every two weeks) are the best methods of delivering TRT. Testosterone in an oral form is not absorbed very well by the body and may increase the risk of high cholesterol, as well as heart and liver problems.

Testosterone therapy risks:

  • Contribute to sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts
  • Cause your body to make too many red blood cells (polycythemia), which can increase the risk of heart disease
  • Cause acne or other skin reactions
  • Stimulate noncancerous growth of the prostate (benign prostatic hyperplasia) and possibly stimulate growth of existing prostate cancer
  • Enlarge breasts
  • Limit sperm production or cause testicle shrinkage
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