Testosterone Hormone Replacement Therapy

Testosterone Hormone Replacement Therapy

Have you seen the latest and greatest men’s health enhancement ads? Unless you live on a deserted island, they’re hard to miss:

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Why so many performance-enhancing supplement Ads?

As a society, we are obsessed with the idea of reversing the inevitable course of aging. Testosterone supplementation does not reverse aging, but it can provide benefits that can improve performance in many aspects of a man’s life.

Who is a candidate for testosterone replacement therapy?

First, it’s important to understand the role of testosterone in a man’s body. Testosterone spikes during puberty, and for boys, this hormone spurs the development and growth of his testicles, scrotum, pubic hair, body shape, strength, fertility, and involuntary erections. Natural testosterone production levels off in the 20’s and eventually starts to decrease, but never down to zero. This decrease with age is also known as andropause or male menopause. Additionally, however, some men experience a sudden drop in testosterone. This drop can lead to more pronounced symptoms leading to depression, anxiety, fatigue, and weight changes.

If a patient has the clinical symptoms and low testosterone levels, he may be a candidate for testosterone supplementation therapy

Diagnostic criteria for testosterone supplementation are based on two, separate early morning testosterone level tests. These blood tests are drawn in the morning because of the diurnal variation, meaning testosterone spikes in the morning and drops to low levels at nighttime. If you have low testosterone levels in the morning when they should be at their highest, then it may be an indication of abnormally low testosterone (normal testosterone reference range: 300 – 890 ng/dL). Criteria also include symptomatic indicators of low testosterone; low libido, poor sexual performance, decreased energy, and fatigue. If a patient has the clinical symptoms and low testosterone levels, he may be a candidate for testosterone supplementation therapy.

Choosing the right testosterone therapy

There are a few types of testosterone therapy and each one is used differently, including nasal sprays, topical gels that are rubbed into the skin, intramuscular injections, or pellets, which are inserted by a trained healthcare provider just beneath the skin. Choosing the type of testosterone therapy to use is a decision that should take several factors into account. Consideration should be given to the physician’s experience and preference, but also your preference. Since testosterone therapy requires a serious amount of dedication, you should feel comfortable with the therapy you choose. Consider how often you want to receive therapy. Gels and nasal sprays are usually used every day, whereas injections are usually only given once a week, or at longer intervals, depending on your physician’s instructions.

It’s important to understand the side effects that may impact your health before embarking on testosterone therapy. Here are some, but not all of the possible side effects: increased red blood cell count, male pattern balding, prostate enlargement, elevated estrogen level, potential worsening cardiac effects1, and increased risk of a blood clot.

Successful testosterone therapy can lead to a higher sex drive and more energy

Low testosterone levels alone can be enough to start treatment, but the vast majority of men experience benefits both in and out of the bedroom. Successful testosterone therapy can lead to a higher sex drive and more energy. Some evidence suggests treatment can lead to increased bone strength, better blood sugar control, and a longer life-span.

The first step is to speak with a doctor about the symptoms you are experiencing, followed by getting morning testosterone blood tests to determine if you’re a candidate for hormone supplementation therapy.

1. Based on JAMA and PLOS 1 study


Seth D. Cohen, MD MPH IF

Seth D. Cohen, MD MPH IF

Assistant Professor of Urology
Director of Sexual Dysfunction Program

NYU Langone Medical Center
Department of Urology
222 East 41st, 11th Floor
New York, New York, 10028
Phone: (646) 825-6318